PLEASE FILL ALL PARTS OF THE FORM
WILL CREDIT BE SOUGHT FOR THE INTERNSHIP? IF YES, IS THE
INTERNSHIP COURSE REQUIRED FOR YOUR DEGREE PROGRAM? YES NO
list two persons not related to you, who are familiar with your
character and qualifications: (Name-address-occupitation or
IS THERE ANYTHING ELSE THAT YOU THINK WE SHOULD KNOW, OR THAT YOU
WOULD LIKE US TO KNOW ABOUT YOU?