2010-2011 Sponsor Information Form
Associate Alumnae of Douglass College Extern Program
181 Ryders Lane · New Brunswick, New Jersey 08901-8557
Phone: (732) 932-2880 Fax: (732) 932-2883
The fields with * are required.
First Name:*
Last Name:*
Are you a Douglass College Alumna?*
Yes
No
If yes, what is your class year?*
Last name as a student?
HOME
Address:
Address 2:
City:
State:
AK
AL
AR
AZ
CA
CO
CT
DC
DE
District Of Columbia
FL
GA
HI
IA
ID
IL
IN
KS
KY
LA
MA
MD
ME
MI
MN
MO
MS
MT
NC
ND
NE
NH
NJ
NM
NV
NY
OH
OK
OR
PA
RI
SC
SD
TN
TX
UT
VA
VT
WA
WI
WV
WY
Zip Code:
Phone:
E-Mail:
BUSINESS
Organization/Company:*
Address:*
Address 2:
City:*
State:*
AK
AL
AR
AZ
CA
CO
CT
DC
DE
District Of Columbia
FL
GA
HI
IA
ID
IL
IN
KS
KY
LA
MA
MD
ME
MI
MN
MO
MS
MT
NC
ND
NE
NH
NJ
NM
NV
NY
OH
OK
OR
PA
RI
SC
SD
TN
TX
UT
VA
VT
WA
WI
WV
WY
Zip Code:*
Phone & Extension:*
Fax:
E-Mail:*
Title:*
Extern Position Information
Job Category:*
Accounting
Arts
Business
Communication
Economics
Education
Finance
Government
Health Care
Hospitality
Human Resources
Law
Management
Marketing
Medicine
Pharmaceutical
Public Health
Public Policy
Public Relations
Science
Social Services
Technology
Other
If other, please describe:
Extern's Title:*
Extern's Responsibilities/Job Description: (Max 1000 characters)*
This is your 'pitch' to all the Douglass students reading the numerous descriptions so please be clear, creative and realistic.
Preferred skills, related majors and other qualifications. (Max 1000 characters)*
Please note that the nature of this program is for our students to ‘try a career on for size’ therefore externships with open qualifications are more likely to be matched with a student who is exploring her options after graduation. If you prefer a student who is more certain of her career plans, please specify.
Please specify the number of extern students you prefer next to the time period(s) you will participate:
Jan. 3-7 #
1
2
3
4
Jan. 3-14 #
1
2
3
4
March 14-18 #
1
2
3
4
If needed, I can provide housing for the student:
Yes
No
Housing notes: (Max 1000 characters)
Other information: (Max 1000 characters)
(Your sponsor information will not be submitted until you see the thank you screen)