MIIC Application - Maryland Institute for Innovative Computing

Employers, please complete this application to be considered for funding from the Maryland Institute for Innovative Computing. This form needs to be filled out for each individual intern position that you are applying for funds. Once submitted, you can also choose to create a copy of this internship for another candidate, or add a new internship position. Your contact information and employer details will carry over each time. (Note: This form works best in Chrome or Firefox browsers with JavaScript enabled.)

Contact Information

Your Name*: First:
Last:

Title*:

Primary phone number*:

Email address*:
(confirmation materials will be sent to this address)

Agency Details

Agency name*:

Website*:

Address 1*:

Address 2:

City*:

State*:

Zip code*:

Short description of your agency (Please provide a few sentences about your organization):

Intern Position Details

Needs to be completed for EACH individual intern position that you are applying for funds.

Semester/Term of Intern Hire*:

Year of Intern Hire*:

Internship Title*:

Position Description*:

Preferred Major(s)*:

How will the internship benefit your agency?*

How will the internship benefit your candidate?*

Have you hired a candidate or made an offer?* Yes No

If yes, indicate candidate's: First name:
Last name:
Email address:

Would you like UMBC to advertise this position for you?* Yes No

If yes, please provide an email address you would like applicants to send documents:

Is this a new internship position for your agency?* Yes No

If you have any other comments that you would like to add to your application, please enter them here:

Payroll Confirmation*
I aknowledge that this intern will be placed on my agency's payroll.
Yes

Application Confirmation*
I certify that the above information is correct and that the funding I am applying for will be used to subsidize a candidate in a technical internship as defined by the Maryland Technology Internship Program.
Yes