Employer Internship Registration

Company Name*

Company Address*

Address Line 1

Address Line 2

City

State

ZIP Code

Company Website URL*

Contact Name*

First Name

Last Name

Contact Title*

Contact Phone*

Contact Email*

Desired Academic Major(s)*

Paid or Unpaid*

Paid Unpaid

Briefly describe your business*

Describe the intern's job description*

Is a car necessary for this placement?*

Yes No

Are there any special skills (including language) that are required or helpful for this placement?*

Number of intern openings per semester (Fall, Spring, Summer)*

Please note the number of openings for each semester.

Have you had interns before?*

Yes No

Have you had Lasell interns before?*

Yes No

Who will supervise the student(s)?

What days and hours would you want the intern to be on site?

(Please keep in mind that the interns are required to spend approximately 150 hours per semester at their internships.)