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Submission Form

Company Name: Department:

Address:

Phone: Ext. Fax:

E-mail: Web site:

Contact: Title:

Number of positions available/semester: Paid?:

Is a car required?: If so, do you reimburse for gas?:

Please describe the internship position and the type of duties the intern will be performing:

Please describe any eligibility requirements or special skills needed for the position:

Any other relevant information/comments?

If you would perfer to print out this page and send it in, please return to Holly Pietromonaco
by fax (323) 851-6748
or mail: Ithaca College Los Angeles Program
James B. Pendleton Center
3800 Barham Blvd., Suite 305
Los Angeles, CA 90068

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