Hope College Biology Department Internship Application
Student Name: _________________________________________________
Date: ____________
Permanent Address
Street Address:
City, State, Zip:
Phone Number:
Student Number: ________________________________________________
Graduation Date: _______________________________________________
Degree Sought: _________________________________________________
Name of Hope Supervisor: _______________________________________
Internship Site (Organization Name and Address)
Organization Name:
Street Address:
City, State, Zip:
When will you be doing your internship? (Fa/Sp/Su): ____________
How many hours per week will you be working?: __________________
Placement Supervisor
Name:
E-Mail:
Title:
Address:
Phone Number:
Description of Internship Activities: __________________________
________________________________________________________________
________________________________________________________________
What objectives will be met by Midterm?: _______________________
________________________________________________________________
________________________________________________________________
Description of Final Project:
________________________________________________________________
________________________________________________________________
Number of Biology Dept Internship credits desired: _____________
Signature of Student: __________________________________________
Signature of Hope Supervisor: __________________________________
Signature of Chair/Biology Department: _________________________