2011-2012 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? If yes, are you an active member of the AADC?* Yes No * Active members support the AADC with a minimum annual commitment of $40. 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 (mobile):* E-Mail:* BUSINESS Organization/Company:* Title:* Field:* 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:* Extern Position Information Job Category:* Accounting Arts Business Communication Economics Education Finance Government Health Care Hospitality Human Resources Law Library Management Marketing Medicine Non Profit 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 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. 2-6* # 1 2 3 4 Jan. 2-13* # 1 2 3 4 March 12-16 # 1 2 3 4 *Due to the holiday, we understand that many workplaces will be working only 4 days the week of January 2. Sponsors located out of the tri-state area: Any alumna or friend is encouraged to offer an externship no matter where he or she is located. Even though the majority of our students are based out of the tri-state area, we do have a growing population from other areas of the country and even abroad. Your location could align perfectly with a student’s plans for winter or spring break. She could be from that area or have friends or family she can stay with. Out-of-state sponsors may also offer housing to our extern students in their own homes. We ask that you please consider this if you live outside the NJ area and are comfortable hosting the student. Housing and transportation is discussed with students during the interview process. If you decide to offer housing, please elaborate below. Matched externships with housing arrangements are handled with extra care. 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)