Title*

First*

Last*

Email*

Phone*

CCDS Relationship*

Alumnus/Alumna  Parent  Faculty/Staff Member  Friend of CCDS  Other 

Field of expertise or career*

You would consider offering

Job Shadowing (8-40 hours) in March, May or June  Summer Internship (3-8 weeks, unpaid)  Other (please describe in the text box below) 

Description

Briefly describe the opportunity you would offer*

Where would this opportunity be located*

City, State

Student

Ideally, what type of student would you prefer? Please list any previous course work, prior experience or age requirement that might be needed or preferred*

Previous Opportunities

If you have offered shadowing/internship opportunities before, could you briefly describe what you have offered?

Referral

If you have other contacts who might be willing to offer and internship, please list their names, job titles, company name and contact information.

Please send a confirmation email to the address below*: