LHS MARKETING INTERNSHIP PROGRAM SURVEY

PLEASE PRINT

Student’s Information Section

Name______

ID# ______Grade _____ Class Period # ______Ad Room #______

Address ______Zip Code ______

Home Phone # ______Cell Phone # ______

List the school activities you are involved in: ______

Parent(s) / Guardian(s) Information Section

FatherMother

Name ______Name______

Home Address______Zip____Home Address______Zip____

Email Address(s) ______Email Address(s) ______

Home Phone # ______Cell # ______Home Phone # ______Cell # ______

Place of Employment ______Place of Employment ______

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SECTIONI: EMPLOYED STUDENTS complete this section.

Name of the business where you work______

Address ______Zip ______

Phone # ______Fax # ______

Name(s) of immediate supervisors(s) ______

Name(s) of relatives that work in the business ______

How long have you worked for your current employer? ______

How many hours do you plan to work each week when school starts? ______

What is your current wage? ______Whatwas your beginning wage? ______

Describe the work duties/tasks you do:

NOTE: If you are interested in different employment, explain why and please complete SECTION II also.

SECTION II: UNEMPLOYED STUDENTS complete this section.

1. Using your past paid work experiences, describe the work duties/tasks you did and identify the

businesses where you have worked. (If you work for a relative, please indicate that).

2. Describe the kind of job you would like to have and/or kind of work duties you would like to learn to do.

3. List the businesses where youwould like to apply to do the kind of work you described in Item #2.

4. List the businesses where you have applied, but not been hired for a job.

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PLEASE SIGN YOUR NAME TO ONE OF THE FOLLOWING OPTIONS.

A. I want to be enrolled in the Marketing Internship Program and earn .5credits for the semester. I understand I have to work an average of ten (10) hours per week.

______

Student’s Signature

B. I want to be enrolled in the Marketing Internship Program and earn1 credit for the semester. I understand I have to work an average of twenty (20) hours per week.

______

Student’s Signature

C. I am not interested in enrolling in the Marketing Internship Program.

______

Student’s Signature