Semester ____________ Year ____________ U.S. Citizen �
| Name ________________________________________________ | ________________________________ |
| First MI Last | Social Security Number |
| Mailing Address _______________________________________ | Work Phone ( ) ________________ |
| Apt. # | Home Phone ( ) ________________ |
| City __________________ State _______________ Zip _______ | E-mail ___________________________ |
| Education | |
| Major : | GPA: |
Computer Applications Courses Taken:
| Course & Section # | Course Title | Credit Hours | Grade* |
|---|---|---|---|
*Use midterm grades if semester is still in progress.
Computer Science Courses Taken:
| Course & Section # | Course Title | Credit Hours | Grade* |
|---|---|---|---|
*Use midterm grades if semester is still in progress.
-over
Mathematics Courses Taken:
| Course & Section # | Course Title | Credit Hours | Grade* |
|---|---|---|---|
*Use midterm grades if semester is still in progress.
English Courses Taken:
| Course & Section # | Course Title | Credit Hours | Grade* |
|---|---|---|---|
*Use midterm grades if semester is still in progress.
Desired number of work hours per week (check as many as apply):
5 hours ____________ 10 hours ____________ 15 hours ____________ 20 hours ____________
Other degrees/certificates/skills:
I certify that the information contained in this application is accurate and complete. I understand this information will be released by Montgomery College to prospective employers to assist me in seeking qualified, college-credit internships. I understand that all hiring and supervisory decisions are the responsibility of the employer, not Montgomery College. I hereby authorize Montgomery College and its employees and representatives to release this application, the information it contains, and any supplemental information from my files and records, to prospective employers upon request.
Student Signature ________________________________________ Date _________________________
(For more information contact Mr. Raymond Kimball at (301) 251-7911. 07/00