Course Reg
istration Approval Form
Internship/Cooperative Education
Course Registration Approval Form
Student Information
Student Name: Student ID:
Email Address: Phone Number:
Major: Minor: Overall GPA:
FR SO JR SR Master's
Expected Graduation Date:
How did you find your Internship / Co-op position?
Internship Information
Company/Agency:
Address:
City/State/Zip Code:
Supervisor: Phone:
Email:
Description of Job Responsibilities:
Faculty Approval
I recommend ___________________________ to participate in the Internship/Cooperative
Education program for ______ hours in the Fall Spring Summer semester of 20___.
_______________________________ __________________
Faculty Signature Date
I have received the syllabus for the internship and understand the requirements for the course.
_______________________________ __________________
Student Signature Date
For Departmental Use Only
Assigned Course Number: ________________________ Course Code: __________________
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Student Form
Internship/Cooperative Education Guidelines & Agreement
Statement of Understanding
1. I understand that Internship / Cooperative Education is an academic program of Texas
Woman’s University, for which academic credit is awarded. I acknowledge that I must
register and pay tuition for the appropriate Internship / Cooperative Education course
when I have accepted a position through the efforts of the Internship / Cooperative
Education Coordinator.
2. I understand that I will not at any time terminate, or arrange with my Internship /
Cooperative Education employer to be released from my job, or arrange additional
Internship / Cooperative Education work terms without prior written approval from the
Pioneer Center for Student Excellence at TWU.
3. I understand that I will ascertain conditions of the work experience prior to accepting a
position. I understand and accept the risks and benefits of the internship accepted and
hold the University, its Regents, officers, and employees harmless with regard to all
matters, including injuries to me, relating to the internship.
4. I understand that I will, to the best of my ability, be responsible for carrying out the
performance of assigned duties and academic requirements of each of the Internship /
Cooperative Education work terms. I understand that academic credit is given when the
term is completed to the satisfaction of the Internship / Cooperative Education program.
5. I understand that I will be on the job regularly and punctually report absences due to
illness or other emergencies to the employer as early as possible on the day the absence
occurs and, if the illness extends beyond three days, I will notify the Internship /
Cooperative Education Coordinator.
6. I understand that once I accept a job assignment, I am required to register and pay full
tuition and fees for the Internship / Cooperative Education course.
_______________________________ __________________
Student’s Signature Date
Photo & Website Release
I give the Pioneer Center for Student Excellence permission to post/use my photograph and
statement, regarding my Internship/Cooperative Education experience, on the TWU website,
social media sites, print material, or campus ads.
Yes No
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Internship Supervisor Form
Internship/Cooperative Education Student Objectives
Student Name: ________________________________ Student ID: _______________________
Statement of Purpose
Brief summary of why you are doing this particular internship/co-op position.
Student Learning Objectives
These should be specific, measurable statements regarding what you want to learn from this
internship/co-op experience.
Objective 1
Objective 2
Objective 3
Skills & Competencies
List the skills and competencies you hope to gain within each objective.
1. __________________________________
2. __________________________________
3. __________________________________
4. __________________________________
Retain a copy of these objectives. You will need them for your Student Final Report.
_______________________________ __________________
Supervisor’s Signature Date
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Internship Supervisor Form
Record of Student Internship Hours
Student Name: _____________________________ Email Address: _______________________
Internship Start Date: _____________________ Internship End Date: _____________________
Unless otherwise agree upon, all hours must be completed within the semester.
Questions? Please contact: Juan Armijo (jarmijo@twu.edu)
Week #
Dates Worked
Total Hours Worked
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
_______________________________ __________________
Supervisor’s Signature Date
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Student Form
Internship / Cooperative Education Final Report
Instructions
Please submit a typed report in a Word document. Answers must be in complete sentence form,
reflective, giving specific examples of situations and tying in your internship experience and
classroom learning.
Example of a complete answer:
Did your Internship site offer you the opportunities you expected in helping you to accomplish
your job objectives? Please explain.
“While I do feel as though I accomplished my objectives, it was in many unexpected ways that I
learned what it takes to be a successful Court Appointed Advocate for battered women. For example,
my #2 objective was “by mid-semester, be able to independently assist women before court in
preparation of seeing their abuser and coaching them through the court process”. I met this goal but did
not realize how much listening would be involved as the women processed their feelings and anxieties
about seeing their abuser in court. I found many of the skills and theories learned in Introduction to
Behavior Therapy and Psychology of Women very helpful. I used reflective listening and reframing to
assist the clients. I accomplished all objectives using similar tools and guidance of my supervisor.”
Final Report Questions
1. Describe your internship responsibilities.
2. What marketable and transferrable skills did you think you learned from this experience,
and how do you think you can use these skills in your academic program, as well as when
you begin working in your chosen field.
3. Describe some of the real-world issues you encountered and describe how these issues
are related to the courses and your learning experience at TWU.
4. Describe how you worked with others with different viewpoints. How did you contribute
to a collaborative team environment?
5. How was your experience in a professional, service-oriented, and/or civic environment
personally meaningful? How do you think this experience will affect your future?
6. How do you think your knowledge, attitudes, and beliefs have changed as a result of your
experience?
7. Thinking about your learning objectives and your chosen internship experience, discuss
how the experience has prepared you for when you begin working in your chosen field.
8. Did your internship site offer you the opportunities you expected in helping you to
accomplish your job objectives?
9. What was the most significant learning experience you gained from your internship work
term?
10. Would you recommend this organization to other students from your field? Why or why
not?
11. After completing the internship process, is there anything the Internship office can do to
make this experience more beneficial for future students in this program?
12. If you selected yes for permission to use your photograph and statement, please list a
quote that highlights why you feel this is a beneficial program.