Bloch School of Business and Public Administration

Edward A. Smith Urban Leadership Internship Program

STUDENT APPLICATION

Directions:  Please type the following application and turn into the Student Services Office, 115 Bloch School, no later than September 30, 2005 in order to be considered for a January-April, 2006 Internship

1.         Name ___________________________________________________________________________

                                    Last                                                     First                                         Middle

2.        Mailing Address ____________________________________________________________________

_________________________________________________________________________________

3.         Email Address______________Phone Number______________Social Security#_________________

4.         Degree Sought _____________Emphasis Area (if applicable) ________________________________

            Anticipated Graduation Date_____________________

5.         Attach a resume OR, on a separate piece of paper, list academic honors, leadership positions, and work experiences (full or part-time).

6.         On one (typewritten) page, please answer the following questions.

A.     Why are you interested in the Edward A. Smith Urban Leadership Internship Program? How do you expect this program to enhance your educational experience?

B.     What role does this community/civic internship play in relation to your personal and professional goals?

7.         List the names, titles, and contact information for two persons acquainted with your academic and/or work experience, who we may contact as references.

            A.___________________________________________________________________________

                        Name                                                              Title                                         Phone

B.___________________________________________________________________________

                        Name                                                              Title                                         Phone

I certify that the foregoing statements and all other information submitted by me in connection with this

application are true and correct.  I understand that the falsification or deliberate omission of information is

grounds for rejection of the application.

            ____________________________________________________________________________

Date Signed                                                                Applicant's Signature

The Board of Curators and the University of Missouri-Kansas City are committed to the policy that there shall be no discrimination on the basis of race, color, creed, sex, age, national origin, disability, or Vietnam era veteran status.  The Vice Provost for Affirmative Action is responsible for all relevant programs and may be contacted at (816) 235-1323.  Office hours are 8:00 am - 5:00 pm, Room 356 of the Administrative Center, 5115 Oak Street.