Internship Project Request Form – Midwest Microelectronics Consortium- MMEC

1. Internship Details

Organization Name(Required)

Point of Contact (POC)(Required)

POC Email(Required)

POC Phone(Required)

Internship Role Title(Required)

Internship Project Description(Required)

2. Internship Project Deliverables

Task 1 – Short Title(Required)

Task 2 – Short Title(Required)

Task 3 - Education Contributions(Required)

Task 4 - Internship Presentation(Required)

3. Internship Requirements

Required Skills(Required)

Any particular student year level

Preferred Course of Study

(e.g., Electrical Engineering, Computer Science)

4. Internship Duration

Weeks

(Number of Week)

Start Date

End Date

Number of Hours per Week

(hours)

5. Anticipated Compensation Per Hour

Anticipated Compensation Per Hour

(amount)

6. Is US Citizenship or US Person required for this position?

7. Would this position contribute to a microcredential, certificates or publications?

8. Do you anticipate that the internship could lead to full-time employment?

9. Do you already have an intern candidate identified or do you need to identify and provide candidates?

Candidate's Name

Candidate's Phone

Candidate's Email

Education Level

10. Do you have any restrictions on whether the Intern needs to be employed by your organization or can they be “loaned” to your organization?

11. Will you be providing all office equipment necessary for the intern, e.g., laptop, desk:

Please list all office equipment you will be providing for the intern (e.g., laptop, desk, chair, phone, software licenses). If there are specific items you will not provide, please specify those as well.(Required)

12. Financial Considerations for Internship Management:

Indirect Cost Item

(Describe the item or service)

Estimated Cost

(Provide the estimated cost)

Proposed Cost Sharing

(Detail how costs might be shared)

Anticipated Benefits

(Explain the benefits to MMEC and the program)

13. Additional Information

Comments

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