5600 U.S. 1 North, Fort Pierce, FL, USA 34946
Phone: (772) 242-2400 FAX: (772) 242-2362 E-mail: HBOIintern@fau.edu
Summer Intern Application Form
Name: ______________________________________________________________________________
Last First Middle
Address: _____________________________________________________________________________
Number/Street City State Zip
Telephone: _____________________________ Date of Birth: ___________________________
Area Code/Number
Email: _______________________________________________________________________________
Permanent Mailing Address and Telephone Number:
Address: _____________________________________________________________________________
Number/Street City State Zip
Telephone: ________________________________
Area Code/Number
Have you ever been employed by FAU? ___ Yes ___ No If yes, date: _______________
If you have an FAU Z#, provide here. _________________________
Are you legally eligible for employment in the US? ___ Yes ___ No
High School
School Name
Years completed at start of
Diploma / Degree
Academic Major
Graduation Date
Summarize special skills, qualifications, training, extracurricular activities, honors received and any
additional information that may be helpful in considering your application:
Preferred mentor(s)
[Click OK to Link to a List]:
Preferred area(s) of research [Click OK to Link to a List]:
I certify that answers given herein are true and complete to the best of my knowledge. I authorize investigation of
all statements contained in this internship application as may be necessary in arriving at selection decisions. I
agree to comply with the policies, rules, regulations and procedures of HBOI/FAU.
__________________________________________ __________________
Signature of Applicant Date
FAU is committed to the principles of engaged teaching, research and service, and reflects this commitment as
a key Platform in its 2015-2025 Strategic Plan. All persons aspiring to achieve excellence in the practice of
these principles are encouraged to apply.
To learn more about FAU's mission and strategic plan, please visit www.fau.edu.
Florida Atlantic University is an equal opportunity/affirmative action/equal access institution and all qualified
applicants will receive consideration for employment without regard to race, color, religion, sex, sexual
orientation, gender identity, national origin, disability status, protected veterans status or any other
characteristic protected by law. Individuals with disabilities requiring accommodation, please call 561-297-
3057. For communication assistance, call 7-1-1.
click to sign
click to edit