Internship Application Form

STATE OF CONNECTICUT
Department of Consumer Protection
450 Columbus Blvd., Suite 901
Hartford, CT 06103

INTERNSHIP APPLICATION FORM

Name:____________________________________________________________
Address: __________________________________________________________
City:________________________   State:__________  Zip Code: ____________
School: ____________________________________________________________
Telephone:___________________                E-mail:______________________

Check one: Undergraduate___ Graduate___    High School ___

For credit? Yes___ No___

If you would like to receive credit, please list any requirements that your school has:

Please specify which division you are interested in working with:__________________
List major: ______________________      Available  start date:________________

Hours and days available:

 Along with this application please send your resume and a cover letter to: