EDINBORO UNIVERSITY OF PENNSYLVANIA
APPLICATION FOR PERMISSION TO REGISTER FOR GRADUATE INTERNSHIP
This is the official application form for requesting authorization to register* for an Edinboro University of Pennsylvania approved
graduate internship. No other application form for internship is valid. After the student receives the copy of the application showing the
internship has been approved, the STUDENT must pay the fees at the Bursar’s Office, then contact Records and Registration to
complete registration for the internship. REGISTRATION MUST BE COMPLETED PRIOR TO THE PROJECTED BEGINNING
DATE OF THE INTERNSHIP.
*Failure to register properly will invalidate this approval.
A one to three-page description of the professional experience and educational outcomes (daily logs, major paper or project, portfolio,
detailed oral report, etc.) that the applicant is to undertake must be attached before submitting this form for approval (if
applicable). Also, the applicant needs to attach a course history.
I. EDUCATIONAL DATA (To be completed by student)
Name: ________________________________________________ Student Identification Number:____________________
Last First M.I.
Address during Internship:
____________________________________________________________________________________________________
Street City State Zip
Home Address (if other than above):
____________________________________________________________________________________________________
Street City State Zip
Email Address: ______________________________ Home Phone: (______) ___________________
Major Field: _____________________________ Anticipated Graduation Date: _________________
II. INTERNSHIP DATA
( ) 1
st
semester, Yr: _______ ( ) 2
nd
Semester, Yr: _______ ( ) Summer Session, Yr: _______
Course Number:_______________________________ Course Subject:_____________________________
Course Title:__________________________________ Number of Credits:________
Proposed Site Supervisor: _________________________________________________________
Phone number of Supervisor:_______________________________________________________
Internship Site: __________________________________________________________________
Address: ___________________________________________________________________________________________________
Street City State Zip
Internship Period: Starts _______/________/_________ Ends: _________/________/_________
Mo. Day Year Mo. Day Year
Number of Weeks:____________________ Hours per Week: __________________
Daily from:___________________ to:___________________ Paid:_________ Nonpaid: ___________
Student’s phone number on site: (______) ___________________ Hourly Amount:____________________
III. INTERNSHIP APPROVAL (the following signatures must be obtained in sequence; copies will be sent to all signers)
Student’s Signature: _____________________________________________ Date:_______________
Advisor’s Signature:_____________________________________________ Date:_______________
Internship Supervisor Signature:____________________________________ Date:_______________
Department Chairperson:__________________________________________ Date:_______________
Academic Program Dean:_________________________________________ Date:_______________
C: APSCUF, Bursar's Office, Records and Registration; Advisor, Internship Supervisor, Student, Graduate Program Head, with all
signatures completed (Responsibility of Graduate Studies Office).
REGISTRATION PROCEDURE FOR INTERNSHIPS
1. The student must complete the Application for Permission to Register for a Graduate Internship and secure all appropriate
signatures required in Section III.
Note: Internships cannot be financed through graduate assistantship awards. Internships can only be conducted at off-campus sites.
2. The application should reach the academic department at least three weeks before the projected starting date of the proposed
internship. Registration cannot be guaranteed if timelines are not met.
3. Registration for an internship must follow these procedures:
(a) The student must make financial arrangements for payment of appropriate fees prior to the proposed starting date
of the internship experience or course. Billing and payments are to be handled through the Bursar’s Office, and;
(b) The student must schedule the course after making payment.
4. Failure by the student to register (as outlined in #3 above) carries the same requirements for registration as other University courses:
(a) The assessment of a late registration fee if registration is not completed prior to the start of the intern-
ship experience, and;
(b) Denial of permission to add the course after the one week add period or equivalent time during the summer session.
5. For internships during the summer, students must complete registration prior to the projected beginning date approved for the
internship, which includes making financial arrangements for payment of appropriate fees.
6. Six-month internships (similar to the Pennsylvania State Civil Service Commission Computer Systems Intern) must follow the
following registration procedure:
(a) If the Internship commences in May or June and ends in December, the student must register in the summer for
a minimum of 9 semester hours and in the subsequent Fall Semester for 15 semester hours, *
OR;
(b) If the Internship commences in January ending in June, the student must register in the Spring Semester for 15
semester hours and in the subsequent summer session for a minimum of 9 semester hours*.
7. All clearances required by the host site must be in place prior to the commencement of the internship.
8. The original application must be returned to the Office of Graduate Studies.
*Students are required to enroll for a total of 24 credits for a six-month internship. However, only 15 credits will apply toward
fulfilling degree requirements.
REV. 5.07.2012
C: APSCUF, Bursar's Office, Records and Registration, Advisor, Internship Supervisor, Student, Graduate Program Head, with all
signatures completed (Responsibility of Graduate Studies Office).
Mail or Fax Completed Form to: Office of Records and Registration, Edinboro University, Hamilton Hall, 210 Glasgow Rd,
Edinboro, PA 16444, Fax: 814.732.2130, Phone: 814.732.3501
Or email this form to: records@edinboro.edu