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MCMA Internship Program Application <br />Jurisdiction Application <br />1. General Information <br />Name of Your Organization: City of Centerville <br />Contact Person: Michael A. Ericson <br />Designated Mentor: same <br />Organization's MCMA Member(s) Name: Michael A. Ericson <br />Address: <br />1880 Main Street <br />Email Address of Mentor: mericson@centervillemn.com <br />Telephone: 651-429-3232 or DID: 651-792-7931 <br />City: Zip: <br />Centerville 55038 <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 responsible <br />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.org <br />Deadline — Friday, January 27, 2017 <br />75 <br />