Join a Regional Industry Council (RIC)

Intern Request Form

First Name
Last Name
Position/Title
Company Name
Company Address
Telephone Number
Email

Please select the Regional Industry Councils that best describe your company:
Check all that apply

Healthcare and Life Science
Energy and Environment
Homeland Security
Aerospace
Global Business
Information Technology
Manufacturing
Engineering and Architecture
Other:

Type of Intern requested:
Check all that apply

High School Student
Undergraduate
Graduate

Do you require a full time or part time internship?

Full Time
Part Time

Length of Time

Start Date: / /
End Date: / /

Will participant be paid?

For unpaid internships please see the NYS DOL Fact sheets for restrictions.

For-profit Guidelines click here

Not-for-profit Guidelines click here

Yes
No

Does participant have to be a U.S. Citizen or Permanent Resident Alien :

Yes
No

Intern Project Title: 


Intern Project Description:


Special qualifications or skills desired:


Suggested readings:


Student Choice(s) – STEM Hub Applicant if known: