First Name:
Last Name:
Middle Initial:
Permanent Address:
Permanent Address 2:
Permanent City:
Permanent State:
AL
AK
AZ
AR
CA
CO
CT
DE
DC
FL
GA
ID
IL
IN
IA
KS
KY
LA
ME
MD
MA
MI
MN
MS
MO
MT
NE
NV
NH
NJ
NM
NY
NC
ND
OH
OK
OR
PA
RI
SC
SD
TN
TX
UT
VT
VI
VA
WA
WV
WI
Permanent Zip:
Local Address:
Local Address 2:
Local City:
Local State:
AL
AK
AZ
AR
CA
CO
CT
DE
DC
FL
GA
ID
IL
IN
IA
KS
KY
LA
ME
MD
MA
MI
MN
MS
MO
MT
NE
NV
NH
NJ
NM
NY
NC
ND
OH
OK
OR
PA
RI
SC
SD
TN
TX
UT
VT
VI
VA
WA
WV
WI
Local Zip:
College/University:
Ashland University
Baldwin-Wallace College
Case Western Reserve University
Cleveland Institute of Art
Cleveland Institute of Music
Cleveland State University
Cuyahoga Community College
Hiram College
John Carroll University
Kent State University
Lake Erie College
Lakeland Community College
Lorain County Community College
Malone College
Mount Union College
Myers University
NE Ohio Universities College of Medicine (NEOUCOM)
Notre Dame College of Ohio
Oberlin College
Siegal College of Judaic Studies
Stark State Colege of Technology
The College of Wooster
University of Akron
Ursuline College
Walsh University
Youngstown State University
Academic Major:
Academic Status:
Freshman
Sophomore
Junior
Senior
5th Year
GPA:
4.00
3.90
3.80
3.70
3.60
3.50
3.40
3.30
3.20
3.10
3.00
2.90
2.80
2.70
2.60
2.50
2.40
2.30
2.20
2.10
2.00
1.90
1.80
1.70
1.60
1.50
1.40
1.30
1.20
1.10
1.00
Citizenship Status:
U.S. Citizen
U.S. Permanent Resident
F-1 Visa Student
J-1 Visa Student
If you are an F-1 or J-1 Visa Student, please list the name of your International Student Coordinator at your college or university:
Your School Email (student@school.edu):
Alternate Email Address:
Daytime Phone:
Evening Phone:
How did you hear about this internship?
Will you earn credit for this internship?
If YES, how will the credit be earned?
If YES above, how many credits will you earn?
Please answer each of the following questions in 150 words or less. What do you think are the most important skills, knowledge or abilities that an entrepreneur should develop?
Tell us about a time when you demonstrated a few of those skills. (This could be in any environment: school, work, family, neighborhood, sports...)
What attracts you to working in a small business or starting your own business?
Do you think that you would ever start your own business?
What do you think are the opportunities and obstacles to starting a business in NE Ohio?
What part of the region, country, or world do you expect to live in after you graduate?
What do you want us to know about you that will help us identify an internship opportunity for you?
Please check your area(s) of interest from the list below:
If OTHER above, please specify:
