Print out the form below, complete, and mail to:

Internship Coordinator
WAVY-TV
300 Wavy Street
Portsmouth, VA 23704

When finished, click below to return to WAVY.COM.

Name: _______________________________________			Soc. Sec. #: _________________
Address: _______________________________ _______________________________________			Phone: _________________
College: _____________		Class of: _______	Major: ___________
Time Period Desired:	Fall (Sept-Dec) Application Deadline: 8/1		Winter (Jan-May) App. Deadline: 12/1
	Summer (Jun-Aug) Application Deadline: 5/1		Other ____________ (Please Specify)
Area of Interest:     Production    News    Sales
Public Affairs    Promotion    The Hampton Roads Show
Previous related experience: ____________________________________
__________________________________________________________
Reasons for seeking Internship: __________________________________
__________________________________________________________
__________________________________________________________
Signature: ______________________________________				Date: ___________
*****TO BE COMPLETED BY FACULTY SPONSOR (please print)*****
Name and Title: ___________________________ ________________________________________				Phone: _________________
Address: __________________________________________________
__________________________________________________________
STUDENT MUST RECEIVE ACADEMIC CREDIT FOR THIS INTERNSHIP				Hours: ___________
Signature: ______________________________________				Date: ____________