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MCMA Internship Program Application <br /> Jurisdiction Application <br /> 1.General Information <br /> Name of Your Organization: <br /> Contact Person: <br /> Designated Mentor: <br /> Organization's MCMA Member(s) Name <br /> Address: City: Zip: <br /> Email Address of Mentor: <br /> Telephone: <br /> 2. Please attach to following to complete your application• <br /> • A work plan detailing intern's duties, to include: <br /> 1. What experiences the jurisdiction intends to convey <br /> 2. The approach to intern's development <br /> 3. Applicant must designate a principal, department head level mentor to be <br /> responsible for the intern's professional development <br /> 4. Regular contact with the jurisdiction's MCMA member during their internship <br /> 5. Designation of the proposed hours per week and rate of pay <br /> 6. The proposed start and end date of the internship <br /> • Letter from the jurisdiction committing to the program and matching fund requirement. <br /> Please attach this form,the work plan,and letter of commitment and forward to: <br /> Susan Arntz, Chair, MCMA Education&Outreach Committee,sarntz@waconia.ore <br /> Deadline— Friday, April 10, 2015 <br /> 46 <br />