Company Application - Interns for Entrepreneurship Program - Discovery Park

Program Time: choose the time period who which to apply for. *

Location of Work Assignments: *

Company Website: (e.g. http://mycompany.com)

Number of part-time employees: *

Number of full-time employees: *

Years in business: *

Company Description: *

Please provide a brief description of your company. Please include what your company does and who it serves.

How many interns does your company request? *

(please note the average award is one-two interns)

Have you had interns through the Interns for Entrepreneurship Program in the past? *

Yes No

Would you like to retain your current intern for another session?

Yes No

Please list your intern’s name:

Supervisors: *

Please list the name and contact information of the person(s) who will supervise this intern.

Who will evaluate the intern? (please check all that apply): *

Immediate Supervisor
Company Intern Coordinator
Other(please specify)

Will the intern be eligible for other professional development opportunities? If so, please list.

(ex. additional training, conferences/meetings, etc.)

Is your company registered in good standing with your State of Origin? *

Yes No

(If No, Please Explain):

Does your company have nondiscrimination and/or anti-harassment policies/reporting procedures (Required for participation in the program)? *

How did you hear about the IfE program? (please check all that apply): *

Email
Mailing/Flyer
Purdue Faculty/Researcher
The Purdue Research Foundation
Former/Current Participant
Website
Other(please specify)

How do you envision an intern contributing to your company? *

(i.e. What type of work will the intern be doing?)

Please list special skills, abilities, or qualities necessary for positions with your company.*

Include any of the following requirements:
citizenship, company application, drug screening, and/or criminal background checks.

Statement of Understanding

The purpose of the Interns for Entrepreneurship Program is to support start-up companies and connect students with potential professional positions. For this objective to be achieved, students must be placed with companies that have the potential to grow and create jobs for Purdue graduates. If accepted into the Interns for Entrepreneurship Program, the employer accepts the following responsibilities related to its participation in the Purdue University Interns for Entrepreneurship Program:

Participate in the IfE selection and matching process. Regularly communicate with the staff during this process and submit all requested materials on time for participation in the program.
Provide internship experience related to the intern’s field of study or skills. The experience should supplement, enhance, and utilize the student’s background. The responsibilities should push the student to expand his/her technical abilities and enhance the student’s educational development. Provide diversified assignments, when applicable, to give the intern a variety of experiences.
Submit an intern agreement form signed by a company representative and the intern, for approval by the Interns for Entrepreneurship staff.
Place the intern under the supervision of a qualified manager who can provide her/him with effective training, guidance during the work session, feedback and evaluation, and can assist the intern in adapting to the work environment and the organization.
Monitor intern hours to verify that they are within the program guidelines.
Communicate regularly with the IfE staff to provide progress reports and immediately report any problems to the IfE staff.
Permit IfE staff to visit the work site and meet with the interns periodically to review the program.
Participate in the assessment process of the IfE program.
Understand that the student is acting independently as an intern for their own educational benefit. The student is not considered to be an employee of Purdue University nor the participating company.
State that the employer is an equal opportunity employer and adhere to the university’s policies on affirmative action. Purdue is committed to providing an environment free of discrimination and harassment and as stated in our Anti-harassment Policy, Purdue "will not tolerate harassment of its faculty, staff, or students by persons conducting business with or visiting the University, even though such persons are not directly affiliated with the University." These policies can be viewed on Purdue’s website for the Office of the Vice-President of Human Relations at www.purdue.edu/HUMANREL.

I have read the Statement of Understanding and the above-named employer accepts these responsibilities related to its participation in the Purdue University Interns for Entrepreneurship Program. *

Contact Name: *
Contact Title: *
Address: *
City: *
State: *
Zip: *
Phone: *	xxx-xxx-xxxx
Fax:	xxx-xxx-xxxx
Email: *

Interns for Entrepreneurship Program

Interns for Entrepreneurship Company Application

Statement of Understanding

Submission of the Employer Application is a sign of acceptance to these terms.

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Interns for Entrepreneurship