Student's Name
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First Name
Last Name
T Number
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Email Address
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Address
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Address 1
Address 2
City
State/Province
Zip/Postal Code
Country
Phone Number
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(###)
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Date of Birth
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MM
DD
YYYY
Gender
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Term for which you desire an internship?
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Current Classification
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GPA
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Estimated Graduation Date
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Relevant coursework
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Please describe any relevant coursework you've taken that are useful for the position that you are applying for.
Academic Advisor First and Last Name
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Academic Advisor's Email Address
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List any special honors/achievements
Spoken Languages
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Are you willing to work during weekends and holidays?
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What is your reason for applying for an internship?
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How does participating in the TSU Tiger Internship Program fit into your personal goals now, and your future career goals?
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What specific goals are you hoping to accomplish during your internship?
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It is extremely important that we maintain a high level of professionalism. What characteristics do you possess that make you an ideal candidate for an internship position?
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Please describe your volunteer experiences.
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Do you have any current certifications?
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What are your areas of interest?
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Have you been convicted of a criminal offense?
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Have you participated in other internship programs before?
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If you answered yes to the previous question, what is the company/organization name?
Do you own a vehicle or rely upon public transportation?
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Intern Work Schedule
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Intern Work Schedule
* Interns can work a max of 8 hours daily, never to exceed 30 hours per week.
* The intern is limited to a maximum of 240 hours.
* Intern who work more than 4 consecutive hours MUST take a minimum 30-minute break.
Please complete the preferred days and hours for the intern/s to work.
Please indicate the preferred time you would want the intern to work
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Please describe your volunteer experiences.
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Emergency Contact Name
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Emergency Contact Phone Number
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Emergency Contact Relationship
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Disclaimer and Signature
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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 the following. The following Agreement is designed to protect all participants in Texas Southern University's ("University's") Tiger Internship Program, including students, faculty members, alumni, Texas Southern University and the agencies/associations and individuals cooperating with the University. You, as the student, must sign this form, with parental or guardian approval if you are under the age of eighteen (18), to indicate agreement and permission to participate.
I understand that I can voluntarily decide to choose a remote or in person internship of my own choice. I further understand the University makes no representation or guarantees regarding the internship including its location and safety. I acknowledge that the decision in selecting a particular internship is entirely voluntary and my own choice. I understand that participation in this internship is entirely voluntary and that my participation in an internship involves some element of risk. I understand that I am responsible for investigating and evaluating for myself the risks associated with my internship. I assume complete responsibility and risk in participating in my internship.
I agree that in consideration of Texas Southern University sponsoring this activity and permitting me to participate, I will indemnify, defend and hold harmless Texas Southern University, Texas Southern University National Alumni Association, their officers, agents, employees, members, successors and assigns from liability for any and all claims, demands, rights or causes of action, present or future, resulting from or arising out of any travel or activity related to my internship. I understand that the University requires that all students be covered by appropriate accident and medical insurance and that the student be financially responsible for such expenses. My signature below verifies that I am covered by the required insurance. Selection of yes certifies the requirements for a legal electronic signature in the state of Texas.
Thank you for partnering with us and supporting TSU students!
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Submission Date
MM
DD
YYYY
