Employer Internship Information Form

  • Please complete this form with as much detail as possible and upon submission it will be sent to the Internship Coordinator and Executive Director of Continuing Education and Regional Development for review and further action. Please do not hesitate to call (814)362-5078 if you have any questions or email Ray Geary at rgeary@pitt.edu.

    Name of Company or Organization:


    City, State, Zip:

    Contact Person/Title:

    Telephone #:

    Fax #:


    Internship Position Title: 




    Will the intern be paid: 



    Detailed Description of Job Duties:


    List Qualifications; Requirements; Preferred Academic Major(s):


    Is Car Required?