Date:
Name Last/First/MI:
Current/Campus Address:
Current/Campus Telephone Number:
Permanent/Home Address:
Permanent/Home Telephone Number:
Date of Birth
Language/s Spoken:
Major/Semester Standing:
Cumulative GPA:	Name of Advisor:
Proposed Date of Internship:
Drivers License:   O Yes   O No
Please list prior job experiences: Job/Title/Company/Duties
Please list 3/4 references (one of whom should be from the University): Name/Title/Contact Information
Computer Proficiency:
Other job related skills
Aim/Reason applying for internship:
Emergency Contact:
Health/Accident Insurance Company:

Please submit all required information to:

UNESCO Chair & Institute of Comparative Human Rights
Room 208, Wilbur Cross
233 Glenbrook Road
Storrs, CT 06269-4124
For more information please call 860.486.0647