GRADUATE INTERNSHIP APPLICATION, Page 2 of 2
 
Other courses or experiences which may qualify you for a placement:

 

 

 
 
Placement preferences: (Type of Agency and Location):
1.
 		 3.
 
2.
 		 4.
 
 
If placement has already been arranged please provide following information:
Supervisor's
Name		 Title
Organization or
Agency
Address
 		 Phone Email
City
 		 State ZIP

Remember to:

  1. Turn this form into faculty internship coordinator.
  2. Obtain an override in order to register.
  3. Register and pay for the internship credit.
  4. With your internship supervisor complete the training agreement and return to the faculty internship coordinator no later than the first week of the internship.
  5. During the internship keep in contact with your faculty internship coordinator.
  6. Keep internship log and write internship papers.
  7. Complete Student Evaluation of Internship form and have internship supervisor complete Evaluation of Intern form.
  8. Turn all work and forms into faculty internship coordinator by deadline.
I understand the requirements of the internship and will comply with all requirements.
signature:
 		 date: