Cooperative Work Experience Education (CWEE)-Occupational
Internship Program--- Off-Campus Internship Request Form
Name of Company: _____________________________________
Internship Position Title: _________________________________
Internship Supervisor:
Address:
Phone:
Email:
# of interns requested:
Semester requested (Fall, Spring, Summer):
Paid or Unpaid
Hours per week:
Is your company open to any of the following student request (please circle):
Informational Interviews: Yes or No
Job Shadow: Yes or No
Internship Description:
Learning Objectives:
Ideally, each learning objective should be able to answer the following four questions:
1. What do you want to learn? (What is the task to be accomplished?)
2. How will you learn it? (How will it be accomplished?)
3. How will the results be measured? (How will it be evaluated and by whom?)
4. When will it be accomplished? (By what date will it be completed?)
Remembering that the learning objective must be specific, measurable, limited to a single
definite result, and have a completion date.
Example: By the end of the semester, the student will strengthen their interpersonal
communication skills by interacting with the public via phone, email, and face-to-face. The site
supervisor will provide formative and summative assessments evaluating this objective.
Cooperative Work Experience Education (CWEE)-Occupational
Internship Program--- Off-Campus Internship Request Form
Learning Activities:
The request must include a description of the learning activities (job duties) that will allow the
student to accomplish the defined learning objectives.
Example: Customer service functions, including: greeting customers, answering telephones, and
answering questions regarding products and services
Experience and Qualifications (Knowledge/Skills/Abilities):
Example: Skilled in Microsoft Excel
Major(s) desired:
Required/recommended coursework:
How to apply:
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