REQUEST FOR LATE REGISTRATION FOR INTERNSHIP
Print this form, obtain the appropriate signatures, and bring to the Division Office for processing.
Note: Any unauthorized changes, altered dates, or forged signatures will result in disciplinary action.
Sections 1 & 2 must be complete BEFORE obtaining the Dean’s signature.
Section 1: General Information (Please print or type all information)
Section 2: Internship Supervisor (Cobleskill Faculty Member) Recommendation
Section 3: Dean’s Signature*
*Dean of the Division in which the course is taught.
Student Name __________________________________________ Student ID# _____________________________
Local Address ___________________________________________ Local Phone _____________________________
City ______________________ State ______ Zip _______________ Current Semester ________________________
CRN _____________ COURSE SUBJ/NUMBER __________________ Instructor _______________________________
Reason(s) for this request: (Please note: Being unaware of the deadline is not a valid reason for an exception)
__________________________________________________ _____________________________________
Student Signature Date
[ ] I support [ ] I DO NOT support the petition. __________________________________ ______________
Signature Date
[ ] I support [ ] I DO NOT support the petition. _________________________________ ______________
Signature Date
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