Fillable Internship Permission to Register (Peru State College)

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Internship Permission to Register (Peru State College)

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  • 10 check-boxes
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File type: PDF

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Fall 2016
Internship Permission to Register
Have you previously enrolled for graduate internship credit? Yes No If yes, how many credits?
I understand that any false information on this or any other internship-related form will be sufficient reason for rejection or
termination of my graduate internship, and I will receive a grade of 'F' for the internship. I herewith authorize and request
PSC to communicate with my internship site supervisor regarding my performance and herewith hold such persons
harmless for giving any and all information within their knowledge or records. It is the responsibility of the graduate
student intern to meet the requirements for the Graduate Program Internship in a timely manner and within the semester
enrolled. Failure to do so may result in termination of the graduate internship or assignment of grade of “F”.
Student Signature
Date
Please allow the above named student to register for the following Graduate Program Internship.
Call No. Dept. Course No. Section No. Credit Hours Semester Year
Dean of Graduate Programs Date
Student Name: Student ID: Date:
City: State: Zip:
Phone:
Address:
Email Address:
Degree:
Education – Curriculum and Instruction
Organizational Management – Entrepreneurial and Economic Development
Yes No I have been admitted to Candidacy for the Graduate Program. (MSED only)
Yes No I have completed at least 18 credits of graduate coursework.
Yes No I am in good academic standing (3.00 GPA or above).
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Internship Permission to Register (Peru State College)

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Completed 23 July 2020

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