Internship Fellowship Online Application

General Information
Name:
Email:
GPA:      Class Year:

Internship Description
Internship Company/Organization:
Internship Address:

If your internship site is not near your hometown, please explain why you have chosen an internship in this location:

Supervisor's name:
How did you find your internship?:
Duties of the internship:
Intership Start Date:
Intership End Date:
Number of days per week:
Number of hours per day:
Salary/stipend or other compensation (housing, meals, mileage, etc):

Budget
Estimated Total Expenses

Housing: explanation:       total:
Travel: explanation:       total:
Food: explanation:       total:
Other (such as required supplies): explanation:       total:
Total Expenses:

Anticipated Total Income

Stipend: explanation:       total:
Hourly pay: explanation:       total:
Other Compensation:
(housing, meals, etc.) 		explanation:       total:
Other awards: explanation:       total:
Other financial support from SLU (research or travel funds, academic departments, international travel funding, financial aid, etc): explanation:       total:
Other income or financial assistance: explanation:       total:
Total Income:
REQUESTED FUNDING:

Optional Additional Explanation:

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