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Please provide at least two professional, academic, or organizational references who can speak to your qualifications, reliability, or experience. Do not list relatives or close friends.

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Primary phone number where we can reach you.
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Optional secondary phone number.
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Select your current academic level.
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If you selected “Other” above, please specify your current academic level.
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Select all internship areas you are interested in. ICCR will review your selections when matching applicants to available opportunities.
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Enter the earliest date you are available to begin your internship. Use MM/DD/YYYY.
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Enter the latest date you are available to complete your internship. Use MM/DD/YYYY.
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Enter the name of your high school and its location (City, State).
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Enter your graduation date or expected graduation date.
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Enter your college or university name and location (City, State). If not applicable, enter “N/A.”
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Enter your degree/program, major, and expected or completed graduation date. If not applicable, enter “N/A.”
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List any academic honors, awards, certifications, or licenses you have earned. If none, you may leave this blank.
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Select the option that accurately reflects your current work authorization status.
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If your work authorization has any restrictions or limitations relevant to this internship, please explain. Otherwise, leave this blank.
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Include paid employment, internships, or other formal work experience.
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Enter the name of your most recent employer or organization.
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Enter the employer’s city and state, or full address if known.
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Enter the employer’s main telephone number, if available.
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Enter the title of the position you held.
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Enter your supervisor’s name and title, if known.
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Enter the month and year you began this position (MM/YYYY).
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Enter the month and year you left this position (MM/YYYY). If you currently work there, enter “Present.”
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Briefly describe your primary responsibilities and duties.
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Select Yes if you would like to provide information for a second employer.
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Enter the name of the second employer or organization.
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Enter the employer’s city and state, or full address if known.
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Enter the employer’s main telephone number, if available.
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Enter the title of the position you held.
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Enter your supervisor’s name and title, if known.
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Enter the month and year you began this position (MM/YYYY).
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Enter the month and year you left this position (MM/YYYY). If you currently work there, enter “Present.”
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Briefly describe your primary responsibilities and duties.
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Enter the reference’s full name.
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Enter the organization, company, or school with which this person is affiliated.
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Describe how you know this person, such as supervisor, professor, teacher, advisor, or coach.
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Enter a telephone number where this reference can be reached.
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Enter the reference’s email address.
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Briefly explain your interest in ICCR, what you hope to learn or contribute, and how this internship relates to your academic, professional, or personal goals.
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Type your full legal name as your electronic signature.
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Enter today’s date using MM/DD/YYYY.
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INTERNSHIPS AT ICCR