First Name *
LAST Name *
Middlebury ID *
Middlebury E-mail *
Class Year *
- Select - 17 17.5 18 18.5 19 19.5 20 20.5
Major *
- Select - Undeclared American Studies Arabic Biochemistry Biology Chemistry Chinese Classical Studies Classics Comparative Literature Computer Science Dance Economics English & American Literatures Envir Sty/Arch & Environment Envir Sty/Conservation Biology Envir Sty/Conservation Psychol Envir Sty/Creative Arts Envir Sty/Environ. Chemistry Envir Sty/Environ. Economics Envir Sty/Environ. Non-Fiction Envir Sty/Environmental Policy Envir Sty/Environmentl Geology Envir Sty/Environmentl History Envir Sty/Geography Envir Sty/Human Ecology Envir Sty/Literature Envir Sty/Relig. Phil. & Envir Film And Media Culture French Gender,Sexuality,Fem. Studies Geography Geology German Hist of Art & Arch/Arch Study Hist of Art & Arch/Hist of Art Hist of Art & Arch/Museum Stdy History Independent Scholar Intl & Global/African Studies Intl & Global/East Asian Stds Intl & Global/European Studies Intl & Global/Latin Amer Stds Intl & Global/Mid East Studies Intl & Global/Russ & E Eur Sts Intl & Global/South Asian Stds Int'l Politics and Economics Italian Japanese Studies Literary Studies Mathematics Molecular Bio & Biochem Music Neuroscience Philosophy Physics Political Science Psychology Religion Russian Sociology Sociology/Anthropology Spanish Studio Art Theatre
Major 2
- None - Undeclared American Studies Arabic Biochemistry Biology Chemistry Chinese Classical Studies Classics Comparative Literature Computer Science Dance Economics English & American Literatures Envir Sty/Arch & Environment Envir Sty/Conservation Biology Envir Sty/Conservation Psychol Envir Sty/Creative Arts Envir Sty/Environ. Chemistry Envir Sty/Environ. Economics Envir Sty/Environ. Non-Fiction Envir Sty/Environmental Policy Envir Sty/Environmentl Geology Envir Sty/Environmentl History Envir Sty/Geography Envir Sty/Human Ecology Envir Sty/Literature Envir Sty/Relig. Phil. & Envir Film And Media Culture French Gender,Sexuality,Fem. Studies Geography Geology German Hist of Art & Arch/Arch Study Hist of Art & Arch/Hist of Art Hist of Art & Arch/Museum Stdy History Independent Scholar Intl & Global/African Studies Intl & Global/East Asian Stds Intl & Global/European Studies Intl & Global/Latin Amer Stds Intl & Global/Mid East Studies Intl & Global/Russ & E Eur Sts Intl & Global/South Asian Stds Int'l Politics and Economics Italian Japanese Studies Literary Studies Mathematics Molecular Bio & Biochem Music Neuroscience Philosophy Physics Political Science Psychology Religion Russian Sociology Sociology/Anthropology Spanish Studio Art Theatre
Name of Organization or Name of Self-Directed Project *
City (location of experience) *
State
- None - Alabama Alaska American Samoa Arizona Arkansas California Colorado Connecticut Delaware District of Columbia Florida Georgia Guam Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Marshall Islands Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Northern Marianas Islands Ohio Oklahoma Oregon Palau Pennsylvania Puerto Rico Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virgin Islands Virginia Washington West Virginia Wisconsin Wyoming
Country *
- Select - United States ---------- Afghanistan Åland Islands Albania Algeria American Samoa Andorra Angola Anguilla Antarctica Antigua/Barbuda Argentina Armenia Aruba Austria Australia Azerbaijan Bahamas Bahrain Bangladesh Barbados Belarus Belgium Belize Benin Bermuda Bhutan Bolivia Bosnia/Herzegovina Botswana Bouvet Island Brazil Brunei Darussalam Bulgaria Burkina Faso Burundi Cambodia Cameroon Canada Cape Verde Cayman Islands Central African Republic Chad Chile China Christmas Island Cocos (Keeling) Islands Colombia Comoros Congo Cook Islands Costa Rica Côte D'Ivoire Croatia Cuba Cyprus Czech Republic Denmark Djibouti Dominica Dominican Republic Ecuador Egypt El Salvador Equatorial Guinea Eritrea Estonia Ethiopia Falkland Islands(Malvinas) Faroe Islands Fiji Finland France French Guiana French Polynesia French Southern Territories Gabon Gambia Georgia Germany Ghana Gibraltar Greece Greenland Grenada Guadeloupe Guam Guatemala Guernsey Guinea Guinea-Bissau Guyana Haiti Heard Island/Mcdonald Islands Honduras Hong Kong Hungary Iceland India Indonesia Iran Iraq Ireland Isle Of Man Israel Italy Jamaica Japan Jersey Jordan Kazakhstan Kenya Kiribati Kuwait Kyrgyzstan Lao Latvia Lebanon Lesotho Liberia Libyan Arab Jamahiriya Liechtenstein Lithuania Luxembourg Macao Macedonia Madagascar Malawi Malaysia Maldives Mali Malta Marshall Islands Martinique Mauritania Mauritius Mayotte Mexico Micronesia Moldova Monaco Mongolia Montenegro Montserrat Morocco Mozambique Myanmar Namibia Nauru Nepal Netherlands Netherlands Antilles New Caledonia New Zealand Nicaragua Niger Nigeria Niue Norfolk Island North Korea Northern Mariana Islands Norway Oman Pakistan Palau Palestine Panama Papua New Guinea Paraguay Peru Philippines Pitcairn Poland Portugal Puerto Rico Qatar Réunion Romania Russian Federation Rwanda St. Barthélemy St. Helena St. Kitts/Nevis St. Lucia St. Martin St. Pierre/Miquelon St. Vincent/The Grenadines Samoa San Marino Sao Tome/Principe Saudi Arabia Senegal Serbia Seychelles Sierra Leone Singapore Slovakia Slovenia Solomon Islands Somalia South Africa South Georgia/Sandwich Islands South Korea Spain Sri Lanka Sudan Suriname Svalbard/Jan Mayen Swaziland Sweden Switzerland Syrian Arab Republic Taiwan Tajikistan Tanzania Thailand Timor-Leste Togo Tokelau Tonga Trinidad And Tobago Tunisia Turkey Turkmenistan Turks/Caicos Islands Tuvalu Uganda Ukraine United Arab Emirates United Kingdom United States Minor Islands Uruguay Uzbekistan Vanuatu Vatican City State Venezuela Viet Nam Virgin Islands, British Virgin Islands, U.S. Wallis/Futuna Western Sahara Yemen Zambia Zimbabwe
Personal Reflection Please answer each question thoroughly and thoughtfully.
1. What were your goals going into the internship/experience? What did you learn? *
2. How did this experience connect to your academic studies? How did you apply your liberal arts learning? *
3) Did the experience provide you with any insights that you had not anticipated? *
4) How might this experience contribute to your studies or aspirations for life after Middlebury? Has it reinforced your ideas or made you think differently about a specific field? How might you continue to use the learning from this experience in your plans for the future? *
Photo Captions *
Please include captions for your two photos. For example: Photo caption #1: Sheila Jones bands baby sea turtles on the coast of Guatemala.
Assessment of the Internship
Would you recommend this internship to another Middlebury student? *
- Select - Yes No
If yes, please briefly describe why you would recommend this internship, or provide advice that may be shared publicly with other Middlebury students?
If no, please explain why you would not recommend this internship. Your answer to this question will be kept strictly confidential.
How did you locate this opportunity?
Describe the organization.
Describe your internship responsibilities.
Cohort Experience The following questions relate to your experience participating in a Middlebury summer cohort program, in which you lived, learned, and/or worked with your peers as a major component of your funded experience. It is very important for us to assess the impact of those programs. Please provide as much information and detail as you can.
Did you participate in a cohort (living, learning, work or service) experience: (FoodWorks, MuseumWorks, Japan Service Learning, Island Design Assembly, or Privilege and Poverty Addison County/Shepherd Consortium)? *
- Select - Yes No
Which cohort program did you participate in this summer? *
- Select - FoodWorks MuseumWorks Japan Service-Learning Program Island Design Assembly Privilege and Poverty Addison County or Shepherd Consortium
Learning Growth Value Please rank the four components below by how significant that component was to your learning and growth this summer, from most to least valuable:
Professional Skills (teamwork, problem-solving, communication, etc.) *
1 - Most Valuable 2 3 4 - Least Valuable
The organization I worked in and its function within the industry *
1 - Most Valuable 2 3 4 - Least Valuable
Overall understanding of the industry *
1 - Most Valuable 2 3 4 - Least Valuable
Personal growth and self-knowledge *
1 - Most Valuable 2 3 4 - Least Valuable
If you were to do the same program again, what would you want more (and/or less) of, to enhance your experience? *