Toggle font size Internship Request Form Name(Required) First Last Phone(Required)Email(Required) What is the name of your educational institution?(Required) Which best describes your degree program(Required) Master's Level Associate's Level Bachelor's Level High School Level What are the total hours for this internship?(Required)What are the total hours per week? What are the beginning and end dates?(Required) Who is the main point of contact for this internship?(Required)What is their title or role? What skills are you building or seeking through this placement?(Required) Can you provide your own:(Required) Laptop Internet connection Transportation What level of supervision do you require?(Required)What are the credentials required of your supervisor? What is your comfort level with working remotely?(Required)We do most of our work virtually. Is a self-directed learning experience a good fit for you? What do you hope to get out of this internship?(Required)E.g., personal interests or exploring new directions/experiencesPlease upload any documents explaining what is expected of you.What does your institution require of your internship? Drop files here or Select files Accepted file types: doc, xls, xlsx, jpg, gif, png, pdf, Max. file size: 32 MB. Why do you wish to intern with the CCC?(Required)How does our organization align with your academic or career goals?Is there anything further you'd like us to know? CAPTCHA