Revised: 4/20/2020
Stockton University Internship Form
General Information
All off-campus Internships require the following documentation:
A Stockton University Internship Form completed three weeks prior to the start of the semester.
A fully-executed (double-signed) Affiliation Agreement form between the
Affiliate/Contractor and Stockton University.
Please note: the Stockton University Internship Form will not be approved until the Affiliation
Agreement has been processed and finalized. This process usually takes approximately 3-4 weeks, so
please plan accordingly. Affiliation Agreements will be managed and processed through the School
Certain internships, such as those with AtlantiCare, or government sites, may require additional
documentation, including (but not limited to): a student site agreement, criminal background check,
and/or 11 Panel Urinalysis Drug Screen.
1. Student contacts faculty member to initiate Internship Project paperwork.
2. Faculty sponsor and student complete Stockton University Internship form.
3. Student brings completed Internship form to the School Office of the sponsoring faculty
a. A designated School staff member reviews the Internship form for accuracy.
b. The staff member requests the student’s contact information and advises the student
that the School Office will contact them when the Affiliation Agreement form has been
executed between the Affiliate/Contractor, and the Internship form has been approved.
c. The School staff member works with the Office of Staff Counsel to process the Affiliation
Agreement forms with the Affiliate/Contractor.
d. Upon completion of an executed Affiliation Agreement, the Internship form is reviewed
and approved or disapproved by the Assistant Dean.
4. The student is notified by the School Office to pick up the form and take it to the Bursar’s Office
for account clearance, and then to the Registrar’s Office for processing.
Important Notes
‘G’ course Internships require the faculty member’s home School Assistant Dean’s approval, for
workload, and then GENS approval for the ‘G” course.
o GENS approval is also required for any W, Q or other attribute designations.
If a faculty member is sponsoring a course outside of their primary program, the home School
Assistant Dean, and the Assistant Dean in the School where the course acronym is housed must
approve the Internship form.
Approvals for Graduate Internships also require the Program Director’s signature in addition to
the Assistant Dean.
Any Internship Forms processed during the Drop/Add Period, Sub-term, or late registrations
must be stamped by the Bursar’s Office prior to processing by the Registrar’s Office.
Revised: 4/20/2020
Stockton University - Internship Form
Term and Year Fall Spring Summer Session IV 20
Academic Information
(to be completed by faculty)
Credit Hours Avg. Weekly Contact Hours Course Acronym Course Number
Level of Project Freshman Sophomore Junior Senior Graduate
Student Name (last, first) Z number
Phone Stockton Email
Faculty Name (last, first) Z number
Office Phone Stockton Email
To be completed by School Dean
This is a W course^
This is a Q course^
GENS Dean Signature
To be completed by
Student Records
Project Title
Project Description and
Requirements *
ELOs Covered
Adapting to Change
Communication Skills
Creativity & Innovation
Critical Thinking
Ethical Reasoning
Global Awareness
Information Literacy &
Research Skills
Program Competence
Quantitative Reasoning
Teamwork & Collaboration
ELO Description
Materials, Readings, and
Evaluation: Methods and
Site Title
Site Website
Site Address
Site Supervisor’s Name
Site Supervisor’s Phone Number
Site Supervisor’s Fax Number
Site Supervisor’s Email Address
This is a stipend internship of $
Project Sponsored By:
Faculty Signature
Project Submitted By:
Student Signature
Graduate Program Director:
(for GRAD programs only)
Graduate Program Director Signature (if applicable)
If General Studies:
Dean (GENS) Signature (if applicable)
Project Approved By:
Dean (Faculty School) Signature
^ Insert a 1 or 2 only in the box; * Course syllabus may be attached if desired, provided all requested information is included