Communication Studies Internship Application

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COM471/472

Student’s Name:___________________________________ | ID#: ____________

Expected Graduation Date:________________________________

Address:

Street:______________________________________________

____________________________________________________

Town/City:____________________ State: __________Zip: __________________

Phone: (        )        -            

Your e-mail: ____________________________________________

Major(s): ___________________________ | Minor(s): ___________________________

GPA (overall)________________

You MUST have 18 Communication Studies credits to do this internship. List the #’s of the six courses you have taken:

__________ | __________ | __________
__________ | __________ | __________

Internship Site AND complete address:

Internship Supervisor:

Number of Expected Credits (1(min.)-6(max.) __________
(Note: 1 credit equals 40-45 hours work experience.)                              

To Be Completed By Sharman Brown, Internship Coordinator

Approved for 1-6 credits: _____ = ______ hrs.

If, after consulting with the intern and the internship supervisor, there is any reason that the internship experience isn’t working to the agreed upon expectations, I may terminate the internship experience.

Signature:______________________________________________

Date:___________________________________________________

Start Date:____________________ Finish Date: ____________________