Full Name *

Address (While Attending School) *

Phone with area code *

E-Mail Address *

Cell Phone *

Permanent Address *

Current College/University *

Major *

2 or 4 Year School Two year school
Four year school
*

Anticipated Graduation Date *

High School Attended

Previous College/University attended

(College/University - clubs, fraternities, offices held, floriculture activities, etc.) *

Grade Point Average to Date *

Previous Work Experience (floral industry):

1. Company Name

Phone:

Supervisor

Job Description

Dates of Employment

Reason for Leaving

2. Company Name

Phone with area code

Supervisor

Job Description

Dates of Employment

Reason for Leaving

Previous Work Experience (non-floral industry):

1. Company Name *

Phone with area code *

Supervisor *

Job Description *

Dates of Employment *

Reason for Leaving *

2. Company Name

Phone with area code

Supervisor

Job Description

Dates of Employment

Reason for Leaving

List one work reference with supervisor name, company, and phone number:

Company Name *

Supervisor Name *

Phone number *

Paid Training Preferences:
Please indicate the dates/months, when you would like to have your training take place.   (Under most conditions, training programs will range from ten to sixteen weeks duration: however, the minimum required is ten weeks.)

I could perform my internship (check all that apply) Jan-Mar
April-June
July-Sept
Oct-Dec
*

Please list the date that you will be ready to begin your training:

Begin ... *

End Date ... *

Primary Training Interest (indicate 1st choice and check others that apply)

The Super Floral Show sponsors a single supermarket internship annually in November. Please check “Supermarket” if you would like to be considered for this scholarship/internship.

First Choice Retail Wholesale Allied Trade Supermarket Other *

Second Choice Retail Wholesale Supermarket Other *

Other - please indicate

First Choice (Preferred) – City, State *

2nd Choice *

3rd Choice

List Company Preference, if any, including location *

Will you have a car available for transportation?

Yes, I will have a car available.

No, I will not have a car available.

Will you have a bike available for transportation?

Yes, I will have a bike available.

No, I will not have a bike available.

Do you have any special medical needs/conditions that we need to be aware of in order for you to be successful during your internship? If so, please list:

List here

Student Agrees:

1.) By signing below the student certifies all the information provided on the application is true and complete, and understands that any misstatement, falsification, or omission of information shall be grounds for rejection of the application or disqualification.

2.) The student agrees to mutually complete the Internship Goal Sheet with the placement employer the first week of the internship.

3.) The student will be disqualified from the program for inappropriate behavior such as any physical or verbal altercations with the employer and/or employees, any illegal use of alcohol or drugs, or any other such behaviors.

4.) The student understands that if he/she does not complete the agreed time period, he/she will be disqualified from the program and will not receive the scholarship.

5.) The student agrees to complete a brief report of the experience (minimum of 500 words) within thirty (30) days of completion, and will supply digital photos to use for in publications and reports. (Photos should also be included in the final report).

Applicant. Enter your full name as your signature *

Date ... *

Advisor Agrees:

1.) To evaluate the applicant carefully and honestly on aptitude, skills, experience and potential as a future member of the floral industry.

2.) To communicate frequently with the Intern throughout the internship.

Floriculture Advisor Signature

Advisor - Print Name

Advisor Phone

Advisor Email

Date