Judicial Internship/Apprenticeship Application Form

Internship Information Form

Political Science Internship Information Form

POSC 447/448/498

When you have found an appropriate internship, please fill out the following and take to SPA 257 so it can be put into your student file.

Remember, always get permission from the Internship Director before starting an internship to make sure that you will receive credit for your internship.

Today’s Date: ______/______/_______

Name (last)_______________________________(first)________________________

Email Address: ___________________@_____________._____

Phone: (_____) _________-_______________

Information about the Internship:

Approximate Start Date: ____/___/ ____;

Approximate End Date: ____/___/ ____

Name of the Org: _____________________________________________________

Address: _________________________________________

City ____________________________   State ________  Zip______________ Phone _____________________________

Name of Internship Supervisor: _________________________________________

Phone Number: (_____) _________-___________________

Email: _________________@__________________._______

Brief Description of Duties and Hours/Week (Use back of sheet if necessary):