Research Internships in Science of the Environment RISE
New RISE Intern Information Form
Once you complete this form don't forget to complete the pre-RISE survey
If you are planning to travel to the site by air the director will make all of the necessary arrangements regarding the flight and your travel to Arkansas State University through Memphis International airport.
NAME
EMAIL
1. DATE of Arrival (June 3 or other negotiated date):
Airport you wish to depart from
2. DATE of Return (Aug 10 unless otherwise negotiated):
Airport you wish to return to (if different from departure)
If you are planning to drive to the site and will be leaving your car on-campus:
Make of car Model of car
Color License plate #
State
With this information I will get you a parking tag that will allow you to park without getting a ticket in the residence hall lots.
Emergency contact information for each RISE intern as well as information regarding any medical conditions or medications that you are taking.
Physician Name:
Physician Phone #:
Emergency contact name:
Relationship:
Address:
Phone:
Medical conditions that you think we should know about?
Allergies to medication?
Medication you are currently taking
5.
SPECIAL NEEDS
If you require a first floor apartment, handicapped accessible, TTD phone, sign language translator etc. please explain below
Copyright 2004 Hannigan
