ࡱ> IKH bjbjVV &<<lT33+++???8w,4?BB.(555AAAAAAApCFLA+50555A33A0909095L3+A095A0909V?@q@pa&?*6X? AB0BB?x^F6^Fq@^F+q@`550955555AA<8555BB5555^F555555555 : FORM I INTERNSHIP AGENCY QUESTIONNARE *MS Word document at  HYPERLINK "http://www.wiu.edu/leja" www.wiu.edu/leja current students, internship forms  Name of Agency: Name of Coordinator: Agency Address: Number Street   City State Zip 4. Phone: Fax: (Area) Number Extension (Area) Number Name of person in agency to contact if coordinator is not available: Name: Phone: What function or activities of your agency do you think will be especially beneficial for students to observe and/or participate in?  If appropriate, what types of research activities would you let our students participate in while they are with your agency?  What is the best length of time for students to stay with your agency? weeks weeks weeks Maximum Minimum Preferred Maximum number of students who can be assigned to your agency at any given time:  Do you foresee any problems pursuant to the sex of the student?  Male Female Explain: List any unique requirements your agency has for the intern, i.e., agency waivers, special applications, dress code, specific hours, etc.  What is the population of your community? How many individuals are employed by your agency? *If you have any additional information that would be helpful to perspective intern candidates, please forward it with this completed form. This form and all internship materials (MS Word documents, text boxes) can be found at  HYPERLINK "http://www.wiu.edu/leja" www.wiu.edu/leja - Current Students, Internship Forms. Thank you! 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