Internship Referral Form - Alpha Delta Pi

Please utilize this form to refer an undergraduate member of Alpha Delta Pi who could be a good fit for our Internship Program with Executive Office! Email Julia Kershner, jkershner@alphadeltapi.com, with any questions.

My Information

First Name

Last Name

Email Address

I am a... I am a...

Please select an option that best reflects your role/how you interact with this woman

Undergraduate's Information

First Name

Last Name

Email Address

Current member at _____ of _____ chapter.

Anticipated graduation semester/year:

I worked with this collegian in their role as...(check all that apply)

If "Other," please specify member's role.

I would describe this member as...(check all that apply)

Please select one:

I know this member is interested in the Internship Program

I am unsure if this member is interested in the Internship Program

I know this member is not currently interested in the Internship Program

I would like to refer this member because...

My Information

Undergraduate's Information

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