LOS ANGELES MULTICULTURAL INTERNSHIPS

Intern Selection Form

Organization

Name of Organization

Getty Marrow Internships at Los Angeles Organizations

Summer 2021

Name of Primary Supervisor

Phone Number

E-mail

(primary supervisor must be full-time paid employee at organization)

Name of Internship (as described on your application form)

Name and Phone Number of Person to contact regarding Intern Selection

(if different from primary supervisor)

Intern Candidate Information

Please provide the following information about your intern candidate, and attach a resume or curriculum vitae.

Last Name

First Name

Middle Name

Permanent Address

City

State

Zip Code

Phone

E-mail (please include email address where they can be reached over the summer)

With which of the underrepresented groups does the candidate identify?

A African American Asian

Latino/Hispanic

Native American

Pacific Islander

Other

Is the intern candidate: Male Female Other Is the intern candidate either a resident of or student in Los Angeles County?

Yes

No

Name of College or University Intern Candidate Currently Attends

Major

Has the intern candidate completed at least one semester of college by June 2021?

Is the intern candidate eligible to be legally employed at your organization?

Yes

Anticipated Month and Year of Graduation

Yes No No

What is the intern candidate's country of citizenship?

Has the intern previously served as a Getty intern at your organization? Yes

No

Is the intern candidate a staff member or relative of a staff or board member of your organization or the Getty Trust? Yes No

Briefly describe the intern candidate's qualifications:

Describe the recruitment and selection process, number of applications received, and criteria used to evaluate applicants:

Proposed start and end dates for the internship (10 consecutive weeks) beginning no sooner than June 7 and ending no later than August 27, 2021:

Start Date:________________________________End Date:________________________________

Have you chosen an alternate candidate in the event your first choice is unable to accept the internship? _ Yes

No

If yes, please provide name below:

Last Name

First Name

Middle Name

Deadline to submit this form and the applicant's resume or curriculum vitae for approval prior to hire: May 17, 2021. Please

scan and upload the completed forms into Fluxx () into the Information on Proposed Intern report form.

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