Permission Request for Internship Academic Credit
Student Information
Name Expected Graduation Date
ID# Phone
Course ACCT
_________________________________
Email
Are you an accounting major?
q
YES
q
NO
Is this your first accounting internship application?
q
YES
q
NO
Have you completed Intermediate II (ACCT 3021) with a “C -” or better?
q
YES
q
NO
Internship Information
Company Name and Address
Company Contact’s Name Phone
Contact’s Email
Description of Internship Duties (Be specific) Attach document with detailed job description
Does the individual primarily responsible for your supervision hold any of the
following certifications? (Check all that apply)
q
CPA
q
CMA
q
CIA
Supervisor’s Name
(If different from company contact)
Phone
Dates of Internship Start Date End Date
Approvals (for Department of Accounting use only)
Faculty Member
Chair
Statement of Understanding: By signing below, I affirm that to receive a “Pass” grade in the internship course, I understand
and am committed to register and work “at least” 20 hours per week, during the respective semester term (excluding university holidays
and scheduled closure times)
_____________________________________________ / __________________________________________________
Printed Name / Signature
_______________________________
Date
Department of Accounting | 501 South Quad Drive | 2800 BEC | Baton Rouge, LA 70803 | lsu.edu/business/accounting
06/18
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signature
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