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    • NMI 5100: Registration Form



    You must fill out the form COMPLETELY or your registration for NMI 5100 will NOT BE APPROVED!

    Name
    Please enter your full name as it appears on all your legal documents.
    Cornell College
    Major
    Cornell Net ID (e.g. "sw57")
    Cornell Student ID NUMBER
    Internship Employer
    Supervisor's Name
    Beginning Date Ending Date
    Employer's Telephone Number
    Employment Address
    This MUST be the physical address where you will be working.
    City State
    Zip Code
    We MUST have the zip code to complete your authorization.

    Commitment:
     I agree to fulfill the following requirements for NMI 5100: (1) to meet with Professors Rosen or Mink to review my project outline, (2) to submit an 8-10-page paper by September 14, 2012, and (3) to revise and resubmit this paper as requested by Professors Rosen or Mink. I understand that I will receive a "U" for the course and that ISSO will be notified if I do not complete the academic component of NMI 510. By not fulfilling the academic component, I also realize that I have worked illegally and my immigration status will be affected.

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