Douglass Externship Experience - Site Mentor Form

• Organization Name *
• Organization Description *
• Organization Website *
• Industry Category *
  [Select Industry Category] Arts and Entertainment Business: Marketing & Communications Business: Supply Chain, Human Resources, Finance Education and Nonprofit Food, Agriculture, Environment, and Natural Resources Health and Medicine Law, Public Policy, and Public Leadership Other Social Services: Social Work, Professional Counseling, Nonprofit STEM: Science for Technology, Engineering, and Math

• Primary Contact Name *
• Primary Contact Title *

• Are you a Rutgers Alum? *

  Yes No

• Are you a Douglass Alumna? *

  Yes No
• Phone Number *
• Email Address *

• Address 1 *
• Address 2
• City *
• State *
  [Select State] Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District Of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming
• ZIP code *

Please Note:

• If you’re hosting externs in multiple locations (e.g. company headquarters and off site), you must create a separate application for each location.
• If you’re hosting externs for different positions (e.g. HR, Marketing, etc.), you must submit a separate application for each position type.

If you need help with filling out this form, contact Dr. Leslie Danehy at 848-932-3184/leslie.danehy@rutgers.edu or Chrissy Oller at 732-235-4747/christine.oller@rutgers.edu

• Please select desired externship sessions: *

  	Externship Session	Number of Opportunities Per Session	Externship Format
  	Winter 2027 - WEEK 1 ONLY (January 4-8)	1 2 3 4 5 6 7 8 9 10	[Select an Externship Format] Fully Remote Hybrid In-Person

Disclaimer: Students will no longer be able to view externship listings and provide preferences of externships they would like to attend. Students will be selected through detailed application questions and an interview. As such, please provide specific details of the following:

• Position description*: Describe what the student will do or experience during their externship.

  An example may include:
  The student will develop an understanding of careers in the pharmaceutical industry, network with scientists in our company, and engage in opportunities for professional development. Toward these ends, the agenda will be tailored toward the student's specific interests and can include opportunities for the student to::

  • Meet with scientists across a variety of disciplines such as drug product formulation, analytical characterization, and manufacturing.
  • Tour the campus, in addition to specific labs performing work of interest to the student.
  • Learn about the pharmaceutical industry and the process of drug development.
  • Participate in a mock interview session.
  • Practice presenting a relevant research article.

  If you are unsure at the time of completing the application, please put “consultation required” and a BOLD staff member will reach out to you for further discussion.

  
  
• Prerequisites: Please be very specific with any prerequisites you may require, if applicable. Prerequisites may include major, career interest, class year (i.e. sophomore, junior), etc. 

  Douglass Residential College pairs externs with Site Mentors based upon the students’ academic and career goals. We give priority to students who are in need of professional development. Therefore, the student you are paired with will likely have little professional experience. If you desire a more seasoned student or specific majors, please indicate this below under prerequisites/requirements. This will be viewable to the student, so please make any requirements appropriate for online viewing. If you would like to make private requests (e.g. to view resumes before placement), please email Chrissy Oller (christine.oller@rutgers.edu).
• Is there any additional information that would be important for our team to know prior to interviewing/matching students to your site?  

• While we will do our best to match students based on any prerequisites or requirements, it may not be possible.

  Yes, I understand *

• I am willing to provide/donate travel funds to the student *

  Yes No

• Is housing available for the student? *

  Yes No
• If yes, indicate type of housing:
  [Select the type of housing] Home Hotel Other

• Have you previously sponsored externs? *

  Yes No
• How did you hear about the Reilly Program at the BOLD Center?
  [Select how you heard about the Reilly Program at the BOLD Center] DRC Alumni Email I've participated before Other Email/Contact Someone I know has participated before