Internship Application

An approved application is required to be registered for the experience. You should review the course description for details, or the department can provide specific internship requirements upon request.

Name Name First Middle Last
How many total credits will you complete during this internship?

How many total credits will you complete during this internship? 1 2 3 4 5 6

** Additional tuition will be incurred if you register for more than 18.0 credits during the term. Students whose GPA is less than 3.00 require special permission from the Registrar (19.0 or 20.0 credits) or Academic Affairs (21.0+ credits) to be registered for a credit overload. **
Term to Apply Credits (Select all that apply)

Term to Apply Credits (Select all that apply) Fall Spring Paying for all credits in the summer (other than the 1 free one)
Will you be working on the internship over the summer?
(1 credit will be applied in the summer)

Will you be working on the internship over the summer?
(1 credit will be applied in the summer) Yes No
How many credits should be applied in the Fall?

How many credits should be applied in the Fall? 1 2 3 4 5 6
How many credits should be applied in the Spring?

How many credits should be applied in the Spring? 1 2 3 4 5 6
Year
Select the Course ID:
Advisor and/or Instructor of record:
Instructor:
Have you been assigned a site supervisor for the internship?

Have you been assigned a site supervisor for the internship? Yes No
Name Name First Last
Phone Phone - ### - ### ####
Email
Approved location for the Internship:
Company Web Site
Description of duties:
Is the internship paid or unpaid?

Is the internship paid or unpaid? Paid Unpaid
Is the internship remote or in person?

Is the internship remote or in person? Remote In person
Have you completed all of your hours for this internship?

Have you completed all of your hours for this internship? All hours complete Currently completing hours
Provide a link to the job description or a detailed list of internship objectives.
What web project management tool (e.g., Office 365, Google Docs, etc.) is this company using for you to submit work online?
Please list any addition technology that you will be required to utilize in this role (if you are aware of any).
Does the internship site require a confidentiality agreement?

Does the internship site require a confidentiality agreement? Yes No
Please upload a copy of the confidentiality agreement.

Attach Files
I understand that I will be expected to collect and submit documentation - including agreements, waivers, and policies - from my internship site to Waynesburg University in order to receive academic credit for this experience.

Draw or Type

I understand this is a legal representation of my signature. Clear

Full Name

I understand this is a legal representation of my signature.