U.S.
CONSULATE GENERAL, MUMBAI, INDIA
FOREIGN NATIONAL STUDENT NONPAID INTERNSHIP APPLICATION FORM
INSTRUCTIONS: Please answer fully and completely, type or print in ink. If more space is needed for an answer, use the space
provided on page 3. Please provide a statement of interest along with this application.
1. PERSONAL INFORMATION
LAST NAME FIRST MIDDLE
PRESENT ADDRESS
TELEPHONE NUMBER AND E-MAIL ADDRESS
YOUR CURRENT CITIZENSHIP OTHER OR PREVIOUS CITIZENSHIPS
2. INTERNSHIP AVAILABILITY - DATES PROPOSED FOR THE INTERNSHIP
START DATE (mm/dd/yy): END DATE (mm/dd/yy): DESIRED LENGHT IN MONTHS:
3. YOUR CURRENT STUDIES
NAME AND LOCATION OF EDUCATIONAL INSTITUTION ENROLLED SINCE MAJOR
4. PREVIOUS EDUCATION (please include high school and above studies)
DATES
NAME AND LOCATION OF EDUCATIONAL INSTITUTION DEGREE MAJOR SUBJECTS
FROM TO
5. ADDITIONAL EDUCATION INFORMATION
SCHOLARSHIPS OR ACADEMIC DISTINCTIONS PUBLICATIONS
6. LANGUAGES (name and indicate the extend of your competence)
SPEAK / UNDERSTAND READ / WRITE
LANGUAGE FAIR GOOD EXCELLENT FAIR GOOD EXCELLENT
ENGLISH
HINDI
OTHER LANGUAGE (Specify language)
7. COMPUTER SKILLS (list programs that you are familiar with)
LITERACY
PROGRAM BASIC INTER-MEDIATE ADVANCED
WORD PROCESSING
SPREADSHEETS
PRESENTATION/DESKTOP PUBLISHER
INTERNET/EMAIL COMMUNICATION
OTHER SOFTWARE, PROGRAMMING,
DATABES (underline needed)
8. EMPLOYMENT (begin with your last or current job, including internships, summer jobs)
DATES OF EMPLOYMENT (month/year, from-to) EXACT TITLE OF YOUR POSITION
NAME AND FULL ADDRESS OF EMPLOYER DUTIES
NAME OF THE IMMEDIATE SUPERVISOR
DATES OF EMPLOYMENT (month/year, from-to) EXACT TITLE OF YOUR POSITION
NAME AND FULL ADDRESS OF EMPLOYER DUTIES
NAME OF THE IMMEDIATE SUPERVISOR
DATES OF EMPLOYMENT (month/year, from-to) EXACT TITLE OF YOUR POSITION
NAME AND FULL ADDRESS OF EMPLOYER DUTIES
NAME OF THE IMMEDIATE SUPERVISOR
9. INSURANCE
I HEREBY CONFIRM I HOLD A HEALTH INSURANCE POLICY (YES/NO)
NAME OF SOCIAL INSURANCE OR COMPANY NAME
POLICY NUMBER
10. SPACE FOR DETAILED ANSWERS
USE THIS SPACE FOR DETAILED ANSWERS. NUMBER YOUR ANSWERS TO CORRESPOND WITH QUESTIONS. ADD
ANY INFORMATION, WHICH WAS NOT COVERED ABOVE AND MAY BE USEFUL TO YOUR APPLICATION. USE
ADDITIONAL PAGES IF NECESSARY.
CERTIFICATION
I HEREWITH CERTIFY THAT THE INFORMATION CONTAINED HEREIN IS CORRECT TO THE BEST OF
MY KNOWLEDGE AND BELIEF.
SIGNATURE DATE