Before beginning any internship for which you wish to
receive academic credit, you must:
|
| Check Type of Internship: |
|
| Check semester you plan to do internship and fill in year: |
|
200___ |
| Current GPA: |
| Student's Name |
ID# | |
| Student's
Local Address |
Local Phone |
|
| City |
State | ZIP |
| Student's
Permanent Address |
Permanent Phone |
|
| City |
State | ZIP |
| Student's
Anticipated Address During Internship |
Anticipated Phone |
|
| City |
State | ZIP |
Major: _____________________________ Minor:
____________________________________
| Courses completed as prerequisites for internship: | |
| 1. | 4. |
| 2. | 5. |
| 3. | 6. |