Industrial-Organizational
Psychology
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Application for
Internship
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Section 1: Student Information:
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Name (Last) (First)
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Student ID Number:
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Phone Number:
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Local Address:
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(City) (State) (Zip)
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Section 2: Internship Information:
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In the space provided below, please describe your proposed internship that includes the
following information:
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1) A summary of the organization (e.g., nature of the business such as the products it
produces or services provided), size of the company, location(s)
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2) A detailed description of the internship duties (e.g., tasks, projects)
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3) Name and background of immediate, on-site supervisor (e.g., job title, length of
employment, educational degree)
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4) Anticipated starting and ending dates
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Internship Site Address:
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(City) (State) (Zip)
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Work Phone:
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Supervisor email:
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Supervisor Phone:
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Section 3: Agreement & Approval Signatures:
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I agree to work for (Print Company Name)
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in the position of (Print position
title):
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By agreeing to this placement, I realize that I am making a professional commitment to
fulfill the duties that I have described, and will abide by any policies of the University of
West Florida and the company concerning interns and/or employees.
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Student Signature:
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Student:
Date:
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Other Signatures:
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Site Supervisor: Date:
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Committee Chair:
Date:
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Committee Member: Date: