Henry Eagle Class of 1943 Internship




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Henry Eagle Class of 1943 Internship


2011 Student Application  Native American Program
Please submit this application, your resumé, and the sponsor form by the deadline (Check with NAP Office for deadline).

Applications are not accepted via blitz.


PERSONAL DATA

Name _______________________________ Class Year ________ Term of Project ______


SS# ________________________ Student ID# ______________ Major(s) ______________________
Hinman Box _________________ Campus Phone ___________
Permanent Telephone __________________________ Cellular Phone _________________________
Permanent Mailing Address ______________________________

______________________________


SPONSOR DATA
Project Title ___________________________________________________________________________
Sponsor Name _________________________________________ Supervisor ______________________

Dates of Internship _____________

1. Describe the organization with which you propose to perform your Henry Eagle ‘43 internship. What is its mission or purpose? How does it fulfill its mission? What community need does it fill? (250-300 words).

2. Describe what your specific role as an intern will be. How will your work serve the community? (250-300 words).

3. What relevant experiences do you have that will help you be successful in completing your internship? (150-200 words).

4. What do you hope to accomplish with the Henry Eagle ’43 internship? (250-300 words).

Budget Proposal\

Travel (one time expense)




Transportation (to/from internship site)




Living Expenses (housing, meals, etc)




Materials & Equipment




Leave Term Earnings




TOTAL



Have you applied for additional funding to support your internship?  Yes  No If “Yes,” please list:



Henry Eagle Class of 1943 Internship


2011 Sponsor Form  Native American Program

Hinman 6037  Hanover, NH 03755

603.646.2110 (phone)  603.646.9168 (fax)

native.american.program@dartmouth.edu



SUPERVISOR’S STATEMENT OF AGREEMENT

The student indicated below is applying for a Henry Eagle Class of 1943 internship (sponsored by Dartmouth College’s Native American Program) at your organization. Submission of information for this agreement signifies to the Native American Program and to the student intern that your organization has agreed to provide the specific work assignment described below, and has appointed a specific supervisor. This agreement is not a legal contract, and is not forwarded to any public agencies. However, it is required by us in order to confirm final funding and/or our placement decisions.


(Organization Name)
agrees to take (Intern Name) ______________________________into the organization to
provide meaningful work experience that fulfills the Henry Eagle Class of 1943 internship criteria
during (check one) Fall ____ Winter _Spring ____Summer ____ term, and to supervise this
work to the degree that at the end of the internship a brief evaluation can be offered by the
supervisor.

Specific description of agreed work assignment and/or other opportunities:

Date ______________________

Supervisor's Name _______________________________________

Supervisor’s Title ________________________________________

Supervisor's Signature ____________________________________

Organization ____________________________________________


Address ________________________________________________
_______________________________________________________

Phone ______________________ Fax _______________________

Is this a non-profit organization?  Yes  No

Is this a tribal organization?  Yes  No

Length of project: weeks

Hours weekly

Starting date Ending date
Return by deadline date of

To: Native American Program

Office of Pluralism and Leadership, Dartmouth College

Hinman 6037

Hanover, NH 03755

Phone: 603.646.2110

Fax: 603.646.9168





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