Modified: 2008-08-12 Page 1 of 2
Chimpanzee and Human Communication Institute
509-963-2244 | chci@cwu.edu | www.cwu.edu/~cwuchci/
PRIM 220 New Student Internship Information Form
Name Date of birth (month, day, year)
Local Contact Information Permanent Contact Information
Street Number, Apartment Number Street Number, Apartment Number
City, State, Zip City, State, Zip
Phone number, including area code
E-mail address CWU Student ID Number
Do you have ASL experience? Yes No Academic Major(s)
Where? # of quarters Academic Minor(s)
Class standing:
Do you have experience with non-human primates?
Yes No
Freshman Sophomore Junior Senior Grad. Student
Expected Graduation Date
Where?
(see # 4 below)
# of months
New CHCI interns will need to meet the following:
(please check each item as you complete it)
1. You must be either
An undergraduate student enrolled in PRIM 220
A graduate student applying with approval from your faculty mentor
2. You must attach results from a tuberculosis test within the last calendar year.
3. You must attach a copy of your weekly class and work schedule.
4. If you have previously worked with non-human primates, you must provide CHCI with a letter of
recommendation from each facility where you worked.
5. You must attach answers to the questions listed on page 2 of this application.
