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* 1. Name

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* 2. Email Address

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* 3. Telephone

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* 4. PhD Title

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* 5. I would be interested in being matched with a suitable internship in a business/organisation (Max 10 days over 10 weeks, for approximately 80 hours)

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* 6. Time available per week? (Days)

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* 7. Please specify your availability between November 2017 and the end of April 2018

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* 8. Please select what type of organisation you are interesting in working for

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* 9. Area of preferred Interest

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* 10. Please list any additional skills you may have (IT, market research, social media, etc.) You MUST complete this section - we need this information in order to match you to a suitable business. 

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* 11. Please provide a brief personal statement on why you would like to do a paid internship.

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* 12. Terms and conditions:
- You must complete the internship in full
- You must make ECCI aware of when the internship starts and when it has been completed
- You must provide feedback to ECCI on your experience 

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