This form should be turned in by the date shown on this syllabus.  You may either: (a) ask the Department of Management secretary to place it in my mailbox, or (b) slide it under my office door (Lowder 409).

1.  Name_______________________________________________  Today's Date: ____________

2.  Student Identification Number:  __ __ __ - __ __ - __ __ __ __

3.  Campus Address and Phone_______________________________________________________

4.  Home Address and Phone_________________________________________________________

5.  List the MIS courses you have already taken or are currently taking:

     _________________________   _________________________   ________________________

     _________________________   _________________________   ________________________

     _________________________   _________________________   ________________________

6.  What semester and year do you want to intern?     ________Semester   _____Year

7.  What semester and year do you plan to graduate?  ________Semester   _____Year

8.  What is your current GPA?   __ . __  __

9.  What geographic location do you prefer?
 _____Only Auburn    _____Prefer Auburn, but will accept Opelika
 _____Only Opelika   _____Prefer Opelika, but will accept Auburn
 _____Either location is equally acceptable
 _____Other (Specify): ________________________________________________

 If you would like to work for a particular organization or type of organization, please describe your preferences below (Note: assignment on the basis of your preferences is not guaranteed).  If you have the name of an appropriate contact person in a specific organization, provide that name.

 _______________________________________________________________________________

 _______________________________________________________________________________

 _______________________________________________________________________________