Reynolds School of Journalism
University of Nevada

INTERN DATA FORM

Semester: __________________________

Name: ____________________________________________________________

Address: __________________________________________________________

Age: _______________________ Hometown: _____________________________

Telephone number at home in Reno ________________ at work ________________

Area of concentration within the journalism major:
_______Advertising
_______Broadcast Journalism
_______Print Journalism
_______Public Relations
_______Other ______________________________________________________

Career Objective: ____________________________________________________

Work experience (What jobs have you held?) _____________________________________

_________________________________________________________________________

_________________________________________________________________________

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Mentor (Name and Title): _____________________________________________________

Company: _________________________________________________________________

Address: _________________________________________________________________

Phone: ___________________________________________________________________

Starting date of internship: ___________________________________________________

Mid-point date of internship: ___________________________________________________

Ending date of internship: _____________________________________________________