Externship program sponsor description form

Name: _______________________ Date: __________

UMW Alumnus: Yes ___ No ___

Major: _____________________ Graduation Year: _______

Employer: __________________________

Job title: ___________________________

Preferred mailing address: ____________________________________________

City __________ State _____ Zip ___________

Is this your home _____ or work ______ address?

Preferred telephone: ( ) Best time to call:

e-mail: _______________Web Site ____________

Brief description of what your organization does: ________ ________ _______

________ ________ ________ ________ ________ ________ ________ __

Brief description of your duties: ________________________________________

___________________________________________________________________

____________________________________________________________________

Possible extern duties: _______________________________________________

__________________________________________________________________

___________________________________________________________________

____________________________________________________________________

Externship is offered:

Winter Break (mid-December to mid-January) ________

Spring Break (second week of March) ________

Summer Break (mid-May to mid-August) ________

Other (will discuss with student) ________

Duration of externship: 1 - 2 days ________ 2 - 3 days _________ 3 - 5 days ________

Please complete this form and return it to the address below. Thank you.

University of Mary Washington

Office of Career Services

Fredericksburg, VA 22401-5358

Phone: 540-654-1022 Fax: 540-654-2442