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MIIC Intern Hire Verification

MIIC is currently accepting intern verification requests for Fall 2022 intern fnding.
This form should be completed by internship candidates after their employer has been approved for the Maryland Institute for Innovative Computing.
 
Agency's MIIC application number*:
(Provided to your employer when they applied for funding.)

Contact Information

Your name*:
First:
Last:
Personal email address *:
If you are not a UMBC student, please do not provide your college "edu" email. Please provide a gmail, yahoo, hotmail, comcast, me.com, etc. email so as not to conflict with any existing Handshake account at your current college.
LinkedIn Profile URL:
Cell/Primary phone number*:

Permanent Address 1*:
Address 2:
City*:
State:*:
Zip code*:

Race:
Gender:

The following describes me (select one that applies to you)*:
Current college student attending a Maryland higher education institution.
Maryland high school graduate attending a higher education institution outside of Maryland.
Graduate (within 12 months) of a Maryland higher education institution.
Maryland resident, with a 2 or 4-year degree, who has been honorably discharged from the U.S. Armed Forces, The National Guard or a Reserve component of the Armed Forces within the last 18 months.
The above categories do not apply to me.

Current/Recent University/College*:
Major(s)*:
Class level*:
Graduation Date*:
MonthYear (YYYY)
Cumulative Grade Point Average*:
Action:
In addition to submitting this form, please send your unofficial transcript verifying your GPA to miic@umbc.edu (PDF attachment preferred).

Hire Data

Agency name*:
Internship Title*:
Internship Start Date*:
MonthYear (YYYY)
Internship End Date (Expected)*:
MonthYear (YYYY)
Hourly Pay Rate*: $/hour
Estimated Hours Per Week*:

Intern Supervisor:
First name*:
Last name*:
Title:
Department:
Primary work phone number*:
Email address*:

How did you find your internship?*

Verification Confirmation*
I certify that the above information is correct and will be used to verify my internship employment as a requirement for Maryland Institute for Innovative Computing funding to your employer.
Yes