Undergraduate | Internships

Name:

Student ID:

Major(s):

Class: Junior Senior

Expected Graduation Date:

E-mail address:

Local Address:

Local Phone:

Address and phone where you can be reached during internship:

If same as local address, just type, "same."

Dates of your proposed internship experience:

How many hours per week will you be working?

Paid Unpaid

Internship title:

Company/organization name and address:

Please provide a brief description of the company or organization.

Please provide a description of the responsibilities you will be expected to perform as an intern at this site.

Site Supervisor's Name and Title:

Site Supervisor's Address:

Site Supervisor's Phone:

Site Supervisor's E-mail address:

Please write a detailed list of learning goals for your internship experience. These should be clear, concise goals that you will use to evaluate your internship at the end of the semester. Please also keep a copy of these goals for your records.

By clicking the box below,

• I agree to abide by all the regulations set forth by Indiana University and the company where I am interning;
• I agree to uphold the highest standards of Indiana University and the Department of Communication and Culture and I understand that failure to do so may constitute a failing grade for the course;
• I understand that I will have to write a paper describing my experience;
• and I understand that I will have to pay for academic credit granted as a result of my internship.

I accept:
I do not accept: