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TRIO Upward Bound at CSUSB Intership Placement Form
First Name
*
Last Name
*
Address
*
City
*
State
*
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
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
Washington DC
Zip Code
*
Cell Phone Number
*
Email Address
*
*
Major or Graduate Program
*
Projected Graduation Date
*
Shirt Size:
*
XS
S
M
L
XL
XXL
Placement Commitment Time/Length:
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One Semester
Two Semesters
One Academic Year
Major Placement Hours Requirement Only
Tutoring/Academic Support: Saturday University:
Tuesday to Thursday, from 4pm-8pm One Saturday out of month, 8am - 1pm
Summer University:
6 week course in the summer
Monday to Thursday, from 8am - 4pm
Which projects are you interested in? Click all that apply
*
Tutoring and Supplemetal Instruction
Saturday University
Field Trips (eg: Campus tours etc.)
Summer University
Residential Week at SummerU
Advising/Coaching
College and Career Readiness Curriculum Development and Implementation
Social/Emotional Skills Development
General; On Call
Availability
🛈
Monday
Tuesday
Wednesday
Thursday
Friday
Saturday
Anytime of Day
Monday
Tuesday
Wednesday
Thursday
Friday
Saturday
8am - 12pm
Monday
Tuesday
Wednesday
Thursday
Friday
Saturday
12pm - 4pm
Monday
Tuesday
Wednesday
Thursday
Friday
Saturday
4pm - 8pm
Monday
Tuesday
Wednesday
Thursday
Friday
Saturday
8pm - 11pm*
Monday
Tuesday
Wednesday
Thursday
Friday
Saturday
Tell us about yourself
What are your career/professional goals
*
What are 2-3 goals that you would like to accomplish during your placement?
*
Reference 1 Name
*
Phone Number
*
Email Address
*
Reference 2 Name
*
Phone Number
*
Email Address
*
Thank You For Your Interest!