ICWS Intern Request Form

Internship Details

Once you have submitted your application for participation in the ICWS Grant, we will review it. Should you qualify, you will be directed to submit your internship job description on to our CareerConnect site. Once approved, it will be labeled as ICWS grant qualified, which students will be able to find and apply for. Our compensation rate for the coming year will be $15.00 an hour. This will translate to a reimbursement rate of $7.50 an hour from your organization to off-set the expense by 50%.

1. Intern Position Title

2. Organization/Agency/Business Name

3. Department if appropriate:

4. Semester(s) this internship opportunity will be offered (check all that apply):

Spring 2023

Summer 2023

5. Recognizing that there is a cap of three ICWS funded interns per a semester, how many ICWS grant funded interns do you intend to accommodate for the fall and spring semesters? This will help us budget for your needs. Summer grant funding will be determined based on remaining funds after the fall and spring semesters have been expended.

6. Business/Organization Website - include link here:

7. Address

8. City, State

9. Zip Code

10. Position Contact Full Name

11. Contact Phone Number answer must be phone number with area code like 217-333-1000

12. Extension (if applicable)

13. Contact Email Address answer must be an email address

14. Expected Number of Hours/Week - No more than 25 hours for the fall 2022 or spring 2023 semesters. Summer hours will be determined based on remaining funds.

15. Intern Supervisor/Mentor Full Name (if different from contact person noted above)

16. Intern Supervisor/Mentor Phone Number (if different from contact person noted above) answer must be phone number with area code like 217-333-1000

17. Extension

18. Intern Supervisor/Mentor Email Address (if different from contact person noted above)

19. Location of Internship (if different from contact person, or not already included in job description);

20. Please check off all of the following;

I understand that the student intern selected must be an Illinois resident in order for ICWS grant funds to be used.

I understand that the student selected will be an employee of the Office of Engaged Learning through the UIS Student Employment program and work at our site as an intern.

I understand that the agreement affiliated through the ICWS grant is separate from the internship course agreement set through UIS. Students participating in the ICWS grant internship are also required to register to participate in the internship course at UIS.

I understand that as part of the obligation for acquiring grant funding this year includes an expectation to support the University's effort for encouraging qualified candidates from marginalized student populations to participate in internship opportunities. This requirement may be fulfilled by attending one social event or a virtual information session as hosted through the Office of Engaged Learning within the coming academic year.

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