Fillable Internship Request Forma

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Internship Request Forma

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Request for Intern
EAM 4106 – Practicum/Internship
Company/Organization Name:
Department:
Supervisor Name:
Title:
Address:
City:
State:
Zip:
Email:
Phone:
Fax:
Website:
Internship Closing
Date (if any):
Hours Per Week:
Unpaid
Paid:
Travel/Living Expense:
None
Yes-Partially
Yes-In Full
Internship Location (if different from above):
Job Description:
Required Skills and Qualifications:
Interested students should contact (who) at (phone, email or address) with (what documents).
*Spring Term: January – Early May; Summer Term: June – Early August; Fall Term: Mid-August – Early December
Student interns must be provided with a minimum of 400 hour of internship experience with work in a pre-professional
capacity, and not merely a clerical capacity. Interns are expected to gain exposure to substantive areas related to
emergency management in their work. Supervisors will be expected to evaluate the intern’s performance at the end of
the internship. Submission of this request is an agreement to the above stated conditions.
Submit requests to: Jamie Earls, Assistant Professor – Internship Coordinator
Department of Emergency Management at Arkansas Tech University
402 West O Street, Dean Hall Room 107e, Russellville, AR 72801
Office: 479-880-4046 Fax: 479-356-2091 Email: jearls@atu.edu
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Internship Request Forma

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Completed 28 February 2020

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