This course provides the opportunity for students to earn credit for career related work experience with a University approved organization.  See the internship guidelines for further information.  The student must supply all information requested and return one copy to the internship coordinator.

Course:  EST 319             Term:_________________             Credit Hours:_______
 

Student Name:____________________________    I. D. Number:___________________
 

Local Street Address:__________________________  Telephone Number:____________
 

City:________________________   State:____________          Zip:_______
 
 

Cooperating Organization:__________________    Work Supervisor:_________________
 

Organization Street Address:____________________________      Title:_____________
 

City:_____________  State:______     Zip:_______  Telephone Number:____________
 

Job Title:____________________________

Period of Work     From:_________________  To:__________________

Number of Hours Per Week:_____________________

Brief Description of Duties:_________________________________________________

_______________________________________________________________________

_______________________________________________________________________
 

The student and the work supervisor agree to comply with all stipulations of Guidelines.
 

Student Signature:______________________________     Date:_______________
 

Supervisor  Signature:__________________________      Date:_______________
 

Internship Coordinator Signature:__________________     Date:______________