EmailMe Form - Media Fellows Internship Stipend Requst Form

Name *

First Last

Phone *

### - ### - ####

Email *

Home Address *

Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country / Region

Internship Site Name *

Internship Site Address *

Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country / Region

Internship Contact Name

First Last

Internship Contact Phone

### - ### - ####

Internship Lodging Address

Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country / Region

Stipend Amount Request Calculator

Enter your amounts and figure your stipend request.

Internship Start Date

1. Rent

$ Dollars

(monthly rent x 3)

2. On-site Transportation

$ Dollars

(bus/subway)

3. Other expenses

$ Dollars

(Itemize in #7, below)

4. Internship Site Stipend

$ Dollars

We use this amount to help assess how much you will be "out of pocket" on the internship.

5. SUBTRACT DePauw Semester Room Cost

$ Dollars

Generally, if the amount you pay for your living unit room per semester is more than the amount you are spending on your internship, your stipend amount will be lower.

6. Request Total *

$ Dollars

Add together 1, 2 and 3. We will factor in any Internship stipends and your DePauw room cost.

7. Any notes about above expenses or un-categorized expenses?