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Employer Internship Information Form

Please complete this form with as much detail as possible and upon submission it will be sent to the Internship Coordinator and Executive Director of Continuing Education and Regional Development for review and further action. If you have any questions contact The Office of Academic Affairs at 814-362-7510 or ljs80@pitt.edu.

Address *
Term *
Will the intern be paid? *
Is a car required? *
12 + 2 =
Solve this simple math problem and enter the result. E.g. for 1+3, enter 4.