Student Internship Application
Instructions: *Please fill out the form completely
*Attach a current resume free of errors
*Return to Kevin Picciuto or Daniel Rivas in room 711B in the Kern
Building
Contact us by phone at: (559) 730-3975 or Email: chutto@cos.edu or danielri@cos.edu
Student Contact Information
Student ID #:___________________________ Today’s Date:_____________________
S
tudent Name:______________________________ Cell Phone:_______________________
S
treet Address:______________________________ City/State/Zip_____________________
E
mail Address:__________________________________________________
Area of Interest or Specific Job Number:
Days of Availability
Write in times of availability:
Mon Tues Wed Thurs Fri
T
ime
Available:
Class: Semester:
List 2 COS Instructors that you have had:
Instructor Name:
1)
2)
Any special skills/languages/Interests: (Please List)
Office Use Only:
GPA Check:___________________ Additional Comments________________________
_____________________________________________________________________________________
_____________________________________________________________________________________
_____________________________________________________________________________________
_____________________________________________________________________________________