Douglass Externship Experience - Site Mentor Form

• Organization Name *
• Organization Description *
• Organization Website *
• Industry Category *
  [Select Industry Category] Arts and Entertainment Business (Supply Chain, Human Resources, Finance) Education, Non-Profit, and Human Services Food, Agriculture, Environment, and Natural Resources Health, General Sciences, Technology, Engineering, and Math Law/Policy Marketing & Communications Other

• 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 *

• Secondary Contact Name
• Secondary Contact Title
• Secondary Contact Phone Number
• Secondary Contact Email

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	Position Type
  	Winter 2025 ONE WEEK (January 6-10)	1 2 3 4 5 6 7 8 9 10	[Select a Position Type] Flexible Based on Student Needs Fully In-Person Fully Remote Hybrid (both in-person and remote)
  	Winter 2025 ONE WEEK (January 13-17)	1 2 3 4 5 6 7 8 9 10	[Select a Position Type] Flexible Based on Student Needs Fully In-Person Fully Remote Hybrid (both in-person and remote)
  	Winter 2025 TWO WEEKS (January 6-17)	1 2 3 4 5 6 7 8 9 10	[Select a Position Type] Flexible Based on Student Needs Fully In-Person Fully Remote Hybrid (both in-person and remote)
  	SPRING 2025 ONE WEEK (March 17-21)	1 2 3 4 5 6 7 8 9 10	[Select a Position Type] Flexible Based on Student Needs Fully In-Person Fully Remote Hybrid (both in-person and remote)
  	SUMMER 2025 ONE WEEK (June 2-6)	1 2 3 4 5 6 7 8 9 10	[Select a Position Type] Flexible Based on Student Needs Fully In-Person Fully Remote Hybrid (both in-person and remote)
  	SUMMER 2025 ONE WEEK (June 9-13)	1 2 3 4 5 6 7 8 9 10	[Select a Position Type] Flexible Based on Student Needs Fully In-Person Fully Remote Hybrid (both in-person and remote)
  	SUMMER 2025 TWO WEEKS (June 2-13)	1 2 3 4 5 6 7 8 9 10	[Select a Position Type] Flexible Based on Student Needs Fully In-Person Fully Remote Hybrid (both in-person and remote)

• Briefly describe what the student would do or experience *
• Please list any prerequisites or requirements for this position (such as specific majors, or year in school)

  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).

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

  Yes, I understand *

• Is this a paid position? *

  Yes No

• 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