Company Contact's Name *

First Name

Last Name

Company's Physical Address *

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Phone Number *

Please list the phone number of the company's contact person

(###)

###

####

Are you a member of any of the following (select all that apply): *

Tiger Alumni Network Member (registered)

Recent Texas Southern University Graduate (last 5 years)

TSUNAA Chapter Member

TSUNAA General Member

TSUNAA Life Member

TSUNAA Associate Member

Interested in becoming a member: https://www.tsunaa.com/membershiptypes

Corporate Partner

Is the business a 501 (c) (3) organization? *

Yes

No

Does employer participate in OJT (On The Job Training)? *

Yes

No

If no, check here if you're interested

Does employer participate in SEAL (Summer Earn and Learn)? *

Yes

No

If no, check here if you're interested

Is the worksite near public transportation? *

Yes

No

Is a drug screen required to be a permanent employee? *

Yes

No

Is a background check required to be a permanent employee? *

Yes

No

Can you provide meaningful work assignments? e.g. Short term projects that you would like to initiate or expand, or research that will enhance a service or a product. *

Yes

No

Do you have adequate office space and equipment for interns (computer, telephone, email account, and desk)? *

Yes

No

Intern will work remotely

If the intern will work remotely, can you offer support and ensure accountability? *

Yes

No

Intern Work Schedule *

*Interns can work a max of 8 hours daily, never to exceed 30 hours per week. *Interns are limited to a maximum of 240 hours. *Interns who work more than 4 consecutive hours MUST take a minimum 30-minute break. Please, complete the preferred days the intern will be requested to work.

Monday

Tuesday

Wednesday

Thursday

Friday

Saturday

Sunday

Please indicate the preferred time you would want the intern to work *

1st Shift: Between 9:00 am - 5:00 pm

2nd Shift: Between 5:00 pm - 1:00 am

3rd Shift: Between 1:00 am - 9:00 am

Other

Disclaimer and Signature

I certify that my answers are true and complete to the best of my knowledge. FURTHER, I HEREBY ACKNOWLEDGE that I have read, understand, and agree to 1. Provide each TSU student employee a professional student package (est. $300 alumni business owner/$500 corporate partner) 2. Attend the TSU Internship Program Awards Business Luncheon 3. Complete intern Syllabus\Project Plan 4. Join Tiger Alumni Network and\or TSU Corporate Partner Directory there too as well. Selection of yes certifies the requirements for a legal electronic signature in the state of Texas.

Yes. I certify that my answers are true and complete to the best of my knowledge.

Thank you for partnering with us and supporting TSU students! *

Submission Date

MM

DD

YYYY