2017 WILLIAMS MICHAEL DIVELY ’61 INTERNSHIP APPLICATION

Today’s Date: ______Application Deadline: 04/28/17

Name______Class______

Major______Concentration ______

E-mail______SU Box ______Phone ______

Name of Organization______

City______State______Country______

Supervisor______Supervisor’s Title: ______

Supervisor’s E-Mail ______Supervisor’s telephone number ______

Organization Web Address______

If you are receiving assistance in the form of a stipend from your internship sponsor what amount? ______

Have you applied for Summer Travel/Research Fellowships, CES grants, Linen funding, Mellon Mays

Undergraduate Fellowship (MMUF), the Allison Davis Research Fellowship (ADRF), etc.? Please list below.

______

______

Please note: If you accept any other Alumni Sponsored Internship Program Grantfrom Williams College for

any projects during the summer of 2017, you are not eligibleto receive the Dively Grant.

In order to be eligible for the Dively Grant, currently enrolled first-years, sophomores and juniors must be in

good standingwith Williams College. The $3,800 Dively Grant is considered taxable income.

Please highlight the industry/field that best describes your sponsoring organization:

Arts (Fine & Performing)

Children/Youth/Education

Community Building/Renewal

Computers/Technology

Consumer Protection

Crime/Safety/Prison Reform

Disabilities

Disaster Relief

Economic Development

Elder Issues

Energy Conservation

Entertainment

Environment

Family /Parenting

Farming/Agriculture

Foundations/Fundraising

Gov’t/Public Policy

Health, Mental or Public

Housing/HomelessnessHuman Rights/Civil Liberties

Immigration

Job Training/Workplace Issues

Journalism

Law

Peace/Conflict Resolution

Poverty /Hunger

Race /Ethnicity

Recovery/AddictionAbuse

Religion/Spiritual Issues

Social Entrepreneurship

Veterans Affairs

Voting/Democracy

Wildlife/Animal Welfare

Women's Issues

Other ______

In addition, you are required to submit a resume and an acceptance letter from your internship supervisor.

The acceptance letter from your internship supervisor must confirm that you will be working full-time

(35-40 hours per week) for at least eight weeks. Your internship supervisor should tell us how

your work during the summer would benefit their organization. If you experience any setbacks in acquiring this letter, please email Dr. Patterson-Stephens for further assistance: .

Please submit your application packet (your resume, the 2017 Dively Application, your responses to our supplemental questions and a letter of acceptance from your internship supervisor) in pdf format to Dr. Patterson-Stephens: sps3@williams. You may also print the materials and submit them to her office in Jenness House.

______

Signed Date

2017 WILLIAMS MICHAEL DIVELY ’61 INTERNSHIP APPLICATION – SUPPLEMENTAL QUESTIONS

Please answer the following questions: (2 pages double-spaced max, in total for all questions):

How would you use the Dively grant money?

How would your internship/fellowship relate to your academic and co-curricular interests?

What personal objectives do you wish to achieve as a result of this opportunity?