Please fill out the application
completely. If any information is missing, your application may be delayed or
rejected. Please print your responses, except for your signature.
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Application Date |
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Student Information |
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Student’s
Name |
Academic Standing During
Internship Term |
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College
or University |
City,
State |
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Major /
Minor |
GPA |
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Temporary
Address |
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Permanent
Address |
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Telephone
(Day) |
Telephone
(Evening) |
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Emergency
Contact Name, Relationship to Student |
Emergency
Contact Telephone Number |
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Area of Interest |
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Internships
are available in the following departments / areas of interest. Hours may
vary depending on the assignment and student schedule. Please indicate your
preference. |
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Assignment Desk |
Sports |
Weather |
Sales |
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Reporting |
Producing |
Editing |
Promotions |
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ABCNews4.com |
Production |
Photojournalism |
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Availability |
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Semester Desired |
Year Desired |
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Weekly Availability (Fifteen Hour Minimum) |
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Days |
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Monday |
Tuesday |
Wednesday |
Thursday |
Friday |
Saturday |
Sunday |
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Nights |
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Monday |
Tuesday |
Wednesday |
Thursday |
Friday |
Saturday |
Sunday |
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Other Obligations |
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Please
indicate additional responsibilities and time commitments you anticipate
during your internship term. Note that we will not use this information to
consider your application, but we may consider it during scheduling. |
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Education
and Training |
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High
School |
City, State |
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Number of Years Attended |
Did
You Graduate? |
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College
/ University |
City, State |
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Number of Years Attended |
Major |
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Overall GPA |
Major GPA |
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Trade
School / |
City, State |
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Date Attended |
Course of Study |
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Certification
or Degree Earned |
Name of Special Designation |
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Software
and Equipment Proficiency |
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Accomplishments
and Awards |
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Prior
Internship Experience |
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Media
Outlet / Organization |
Date |
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Internship Coordinator |
Telephone Number or Email Address |
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Activities, Accomplishments, etc. |
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Media
Outlet / Organization |
Date |
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Internship Coordinator |
Telephone Number or Email Address |
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Activities, Accomplishments, etc. |
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Media
Outlet / Organization |
Date |
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Internship Coordinator |
Telephone Number or Email Address |
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Activities, Accomplishments, etc. |
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Employment
History |
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Most
Recent Employer |
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Company Name |
City, State |
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Title |
Dates of Employment |
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Supervisor / Title |
Telephone |
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Duties |
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Reason for Leaving |
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May We Call for a Reference? |
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Second
Most Recent Employer |
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Company Name |
City, State |
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Title |
Dates of Employment |
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Supervisor / Title |
Telephone |
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Duties |
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Reason for Leaving |
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May We Call for a Reference? |
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Third
Most Recent Employer |
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Company Name |
City, State |
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Title |
Dates of Employment |
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Supervisor / Title |
Telephone |
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Duties |
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Reason for Leaving |
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References |
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Please list the names and numbers and / or email
addresses of three references we may contact. |
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Name / Title |
Phone Number / Email Address |
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Name / Title |
Phone Number / Email Address |
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Name / Title |
Phone Number / Email Address |
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Internship
Candidate Questionnaire |
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Why are you interested in television news? |
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Briefly describe why you wish to participate in
our internship program. |
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Briefly describe your goals for the internship. |
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What expectations do you have once you have
completed your internship here? |
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Statement
of Truth |
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I certify that the
information on this application is accurate, complete and subject to
verification. I authorize and release from liability all individuals and
organizations to provide information requested by this Station for the purposes
of processing this application. I indemnify the Station, its shareholders and
their officers, directors and representatives from any and all liability that
may result from making such an investigation. I further certify that the
information that I have provided on this application and in any interview is
true and accurate as well as all other documentation submitted with this
application (such as my resume), and I understand that any misrepresentation,
whenever discovered, is cause for immediate dismissal from the internship
program. I understand this application is active, if I continue to desire
participation in the internship program and have not been offered placement,
for six months from the date of completion and signature. At the end of that time
period, a new application must be furnished if I remain interested in
participation in the internship program with the Station. |
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Printed Name |
Date |
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Signature of Intern Candidate |
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Verification
of Academic Credit |
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This verifies that the
student listed below qualifies to participate in the WCIV-TV/DT, ABC News 4
internship program and will be eligible to receive course credits upon
successful completion of the internship term. |
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Student’s Name |
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College / University |
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Number
of Course Credits to be Earned |
Minimum
Number of Work Hours Required |
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Student Internship Advisor |
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Mailing Address |
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Phone Number |
Fax Number |
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Email Address |
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Student Internship Advisor’s Signature |
Date |
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An Allbritton Communications Station
WCIV-TV/DT,
ABC News 4
Phone
Fax (843)
849-2519
http://www.abcnews4.com