Revised: 6/2017
Internship Form
Student Name
Student ID#
The above-named student has permission to register for the following Internship:
Department Name and Number:
_____ 270 _____ 370 _____ 470 _____
Semester & Year:
Fall Spring Summer YEAR: 20______
Course title exactly as you wish it to
appear in your transcript:
Will the Internship require an ENGAGE
Yes No
# Credits:
Part of term:
Courses MUST be approved and added before the end of the drop/add period.
Student acceptance of charges and responsibilities:
The Registrar’s Office will notify me at my Utica College e-mail address of any problems with this registration:
o If I have a hold on my account, I will not be registered for the internship.
o If adding this internship will exceed my maximum hours, I will need to request an increase of my maximum hours or drop a course.
I accept responsibility for ensuring that this course is appropriate to my degree program.
I accept responsibility for all charges incurred as a result of my registration.
I understand that charges and registration are available for viewing on Banner Web.
I am responsible for the accuracy of all information I submit to the College.
I agree to notify the Registrar’s Office in writing of any withdrawal, or other change that affects my enrollment status in this class or be subject
to all charges.
If charges are incurred while attending and it should be necessary for Utica College to use a collection agency, which is subject to the Fair Debt
Collection Practices Act, I agree to pay all collection costs and attorney's fees.
In the event I qualify for Title IV federal funds, I authorize the College to use these funds to pay for all allowable charges beyond tuition, fees,
room and board. I understand that due to federal regulations, my financial aid package is based upon a minimum registration requirement after
drop/add period. If minimum requirements are not met, I will not be eligible for certain aid programs and will be responsible to pay any balance
in full prior to participating in future registration periods or the release of transcripts.
Traditional campus students who do not pay the balance in full will be automatically enrolled in a payment plan and charged a deferred
payment fee.
If I fail to meet payment arrangement deadlines, I will experience delays in finalizing my registration, I may be dropped from my course, and if
applicable, may be removed from campus housing and have my meal plan canceled.
Academic deadlines are posted on the College website. Links are available from the Registrar’s home page:
If I withdraw after the deadline, I will be given a grade of WF, which will calculate as an “F” in my GPA.
Student Signature (REQUIRED): _________________________________________ Date: _______________
Supervisor’s Name (PRINT):
Supervisor’s Signature:
Chair’s Signature:
Dean’s Signature:
Once all signatures are in place, please submit to the Registrar’s Office (123 White Hall) to process.
Registration Completed: CRN: __________ Part of Term: ________ Date Registered: _____________ Initials: ________