Fill - Free fillable ExerciseScienceHandbookAppB APPENDIX B PDF form

APPENDIX B

INTERNSHIP APPLICATION

Instructions:

1. This form is to be completed by the student

2. Please type or print legibly in black ink

3. Complete all spaces

4. Submit the completed form to University Field Experience Supervisor

Section I (To be completed by the student)

Name: __________________________________________

S.S.# __________________________________________

Local Address: __________________________________________

Permanent Address: _______________________________________

City, State: __________________________________________

Zip:

E-mail: ___________________________________________

Phone: ____________________________________________

Cell Phone: ________________________________________

Semester you plan to register for this field experience (check on and indicate year):

Fall

Spring Summer

Start Date:

Completion Date:

Section II (To be completed by the student)

Information on Proposed Internship Site:

Name of Agency:

Site Supervisor: __________________________________________________

Site Supervisor Title: _______________________________________________

Address:

City, State, Zip:

Phone ( ) _____________________

Print Form

Submit by Email

Section III: (To be completed by the student)

Briefly respond to the following questions:

Why did you choose this agency for your internship experience?

Have you been previously associated with this agency?

(If so, in what capacity and when? If not, how was the initial contact made?)

What do you hope to learn from this internship?

How do you think this internship will influence your career plans?

If you know, provide a list of the tasks and projects you will be involved in during your internship?

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