The Office of Laboratory Experiences

Completing the information below will allow you to access the year-long intenship on-line application procedure. In addition, you will need this access for your year-long internship performance assessment program.

Today's Date:
First Name:			Last Name:
Student ID#:			E-mail Address:
Sex:	Male Female
Local Address:
Local City:		Local State:		Local Zip Code:
Local Phone:
Permanent Address:
Permanent City:		Permanent State:		Permanent Zip Code:
Permanent Phone:
Select a User ID:	Your e-mail address will be your User ID
Select a Password:
Re-type Password: