Internship Opportunity Form

Please use this form to register your desire to host an Intern, at no charge, in your emergency management agency. 

All fields below MUST be addressed. 

Jurisdiction	*
First Name	*	Last Name*
Address		Address 2
City		State/Province Zip/Postal
Jurisdiction Type	*	County Multi-County Municipality Multi-Municipality School Township Not applicable
County	*	Adams Alexander Bond Boone Brown Bureau Calhoun Carroll Cass Champaign Christian Clark Clay Clinton Coles Cook Crawford Cumberland De Witt DeKalb Douglas DuPage Edgar Edwards Effingham Fayette Ford Franklin Fulton Gallatin Greene Grundy Hamilton Hancock Hardin Henderson Henry Iroquois Jackson Jasper Jefferson Jersey Jo Daviess Johnson Kane Kankakee Kendall Knox Lake LaSalle Lawrence Lee Livingston Logan Macon Macoupin Madison Marion Marshall Mason Massac McDonough McHenry McLean Menard Mercer Monroe Montgomery Morgan Moultrie Ogle Peoria Perry Piatt Pike Pope Pulaski Putnam Randolph Richland Rock Island Saline Sangamon Schuyler Scott Shelby St. Clair Stark Stephenson Tazewell Union Vermilion Wabash Warren Washington Wayne White Whiteside Will Williamson Winnebago Woodford none
Email Address	*
Phone		Extension
The intern is requested to work:	*	Full Time Part Time Either
Resources		Desk / Workspace Telephone Email Mobile Phone Position Description Computer Internet Access Uniform
Please describe the focus of the internship, including projects to be undertaken, stakeholder meetings to be attended, training opportunities and general objectives, and any other items of interest to students seeking opportunities.
Description
Parties who submit an Intern Interest Form to IESMA will receive an Internship Development Packet to assist in their opportunity promotion. Questions regarding intern opportunities can be directed to the IESMA Student Affairs Committee. (Currently chaired by Tom Smith @ Palatine Emergency Management Agency)
What semester do you have project work available for the intern		Spring Summer Fall Winter
What core EMA phase will the intern focus on?		Preparedness Recovery Mitigation Response
Can We Contact You?		Yes - via phone Yes - via email No
Security Code	*