Step 1 of 2 50% Admin OnlyCRN(Required)Amount(Required)Fund #(Required)ApplicationName(Required) First Last Email(Required) Enter Email Confirm Email Student ID #(Required)Major(Required)Please chooseAddiction Studies Certificate (ASC) CERTAdventure Education (ADE) ASAllied Health (ALH) ASAllied Health/Dental Assisting Intent (ALH) ASAllied Health/Kinesiology Transfer Intent (ALH) ASAllied Health/LPN Intent (ALH) ASAllied Health/Nutrition Transfer Intent (ALH) ASAllied Health/PMC Intent (ALH) ASAllied Health/Physical Therapy Assistant Intent (ALH) ASAllied Health/Public Health Transfer Intent (ALH) ASAllied Health/Radiologic Technology Intent (ALH) ASAllied Health/Respiratory Therapy Intent (ALH) ASAllied Health/RN Intent (ALH) ASAllied Health/SGT (ALH) ASArt/Visual Art Transfer Block (AVC) ASArt/Visual Arts (AVA) ASBiology (BIO) ASBusiness Administration General (BAG) ASBusiness Administration Transfer (BAT) AAChemistry (CHE) ASComputer Science (CSC) ASEarly Childhood Education (ECE) ASEarly Childhood Education Certificate (CECE) CERTEngineering Science (EGS) ASEnvironmental Conservation (ENC) ASFarm and Food Systems (LFF) AAFire Science Technology (FST) ASHuman Services (HSE) ASJustice Studies (JUS) ASLiberal Arts (LIB) AALiberal Arts/Contemporary Music Studies (LCMS) AALiberal Arts/Education (LEO) AALiberal Arts/English (LAE) AALiberal Arts/Farm and Food Systems (LFF) AALiberal Arts/History (LHI) AALiberal Arts/Mathematics (LMA) AALiberal Arts/Social Sciences (LSS) AALiberal Arts/Theater (LAT) AAManagement Certificate (MGT) CERTMedical Assistant Certificate (MAC) CERTMusic Recording and Production Certificate (MRP) CERTOutdoor Leadership Certificate (OLP) CERTPlant & Soil Science (PSS) ASPre-Nursing (NUC) CERTPre-Nursing/ADN Intent (NUC) CERTPre-Nursing/LPN Intent (NUC) CERTPre-Nursing/Nursing Bridge Intent (NUC) CERT ** ONLY AVAILABLE FOR PRACTICAL NURSES **Visual Arts Certificate (VAC) CERTWeb Development & Design Certificate (WDD) CERTWorld Language in French (WFR) CERTWorld Language in Spanish (WSP) CERTPhoneAge(Required) Under 18 Over 18 Parent/Guardian Name(Required) First Last Parent/Guardian Email(Required) Enter Email Confirm Email A 294-level internship indicates you have already completed a 293-level internship in the same field of study. E.g., after completing BIO 293 Internship in Biology you would then take BIO 294 Internship in Biology. Refer to the internship website for more information. Course Number(Required)293 - Internship I294 - Internship IISubject(Required)Please ChooseACCACSAGRAHSALHANTARTASLBIOBUSCHECISCMNCRJCSCECOEDUEGREGTEMSENGEVSFREFSTGEOGWSHISHSVHUDHUMJUSLATMACMATMOMMUSNUROLPPCSPHIPHYPOLPSYREESCISGTSOCSPATHEThis field is hidden when viewing the formDean Nursing This field is hidden when viewing the formDean Allied Health This field is hidden when viewing the formDean Liberal Arts This field is hidden when viewing the formGrouping Melanie This field is hidden when viewing the formGrouping Amy This field is hidden when viewing the formGrouping Credits(Required)Please Choose123456Term(Required)Please ChooseFallSpringSummer ISummer IIFull Summer (I & II)Year(Required)Please Choose2026Faculty Mentor(Required) First Last Faculty Mentor Email(Required)Make sure to get this part right! Your mentor will be sent a copy of your application to approve; if their address is not accurate, they won't get the email! Enter Email Confirm Email Internship Site(Required)Name of company/organization & locationSite Supervisor(Required) First Last Site Supervisor Email(Required)Make sure to get this part right! Your site contact will be sent a copy of your proposal to approve; if their address is not accurate, they won't get the email! Enter Email Confirm Email Site Contact Phone(Required)Complete the next section in consultation with your Faculty Mentor. Field of Focus or Area of Study(Required)Mentor Meetings(Required)How often and for what purpose will you meet with or contact your Faculty Mentor?Length of Internship(Required)Approximately how many weeks will the internship last?Weekly Hours(Required)Approximately how many hours per week will you be working? List min/max hours per week as well.Start Date(Required) The start date of your internship can not be before the first day of classes for the termEnd Date(Required) The end date of your internship can not be after the last day of classes for the term—however please indicate the actual end date if you will complete your internships prior to the end of the term Learning PlanWhat do you hope to gain from this internship?(Required)List specific learning objectivesWhat will your internship site gain?(Required)How will the organization or company benefit from your placement?How will you demonstrate success in achieving these learning objectives?(Required)Examples could include a daily journal of your experiences, research papers, a portfolio of creations, etc.Acknowledgement & Attestation(Required) I understand I may be subject to and will comply with CORI requirements I understand I may be required to and will submit additional health and immunization information I have read and understand GCC's Title IX/Affirmative Action policies I attest that the information in this application is correct This field is hidden when viewing the formInternship Coordinator This field is hidden when viewing the formVP Academic Affairs This field is hidden when viewing the formMelanie This field is hidden when viewing the formDawn This field is hidden when viewing the formVP/Dean This field is hidden when viewing the formGrouping Admin 1 This field is hidden when viewing the formGrouping Admin 2 This field is hidden when viewing the formGrouping Admin 3 Heads up! Once you submit this form, you will be redirected to electronically sign our Acknowledgement of Risk & Consent. Your application will not be complete without this signature!