INTERNSHIP PROGRAM – 2021/22 APPLICATION FORM

Please fill out the form, print it and mail it along with the required documentation to
the contact information on the second page of this form.

General Information
Name: Gonzalez Velasquez ____Medardo Antonio _____________________________
Last First

Current Mailing Address: Called 30 # 2 Este -90 Apartment 504 Tower 7

Street Address Apartment/Unit #
Fusagasuga Cundinamarca 252211
City Province Postal Code

Permanent Address: Called 30 # 2 Este -90 Apartment 504 Tower 7

Street Address Apartment/Unit #
Fusagasuga Cundinamarca 252211
City Province Postal Code

Current Permanent
Telephone Number: 3142331393 Telephone Number: 3142331393

Email Address: merardogonzalez2205@hotmail.com

Education
High School Attended: Institution departmental AguaBonita Year of Graduation: 2009

Present University: Foundation University San Mateo Career engineering telecommunications

Degree(s)
Expected: _______ engineering telecommunications _____________________________

Work Experience
Place of Employment: Rama Judicial Ut-icom From: __2019_

Duties: supported systems To: 2021

Place of Employment: Selcomp Ingenieria From: 2013

Duties: supported systems To: 2019

Place of Employment: Avidesa Macpollo From: _2013_

Duties: Practices supported systems To: 2013

1
 Scholarships and/or other Academic Awards
Educate scholarship 50%

Extracurricular Activities & Interests

References

Names & Addresses of 3 academic referees who are familiar with your work
during the most recent 2 years of study.

Referees are to submit these items and should provide letters of reference directly to the Clerk’s Office. (A
completed application form includes 3 letters of reference from your academic referees).

Marisela Romero 3118648596 maryselaa88@hotmail.com

Freddy Esteban Gonzalez 3103247370 gonzalezvelasquez1993@gmail.com
Luz Adriana Cortes 316 2478735 coordinador.zcentro@procoexpo.com