Wesley College Internship Application
Student Name: _______________________ I.D#: ____________ Major: _____________________
Course Name/Number: ________________ Semester/Year: __________ Class Standing: ____________
Your Address while on Internship: ___________________________________________________________
Street City State Zip
Your Phone: __________________________ Your E-Mail: ______________________________________
Student must turn this completed form in to the Registrar’s Office AND register for the section of Internship
as a credit class at the same time. This must be done before the final day of the add/drop period in the term in
which the internship course is to be taken. No internship credit will be granted retroactively.
OBTAIN SIGNATURES IN THE ORDER SHOWN
(1) Student: ____________________________________________ Date __________________
(2) Course/Internship Instructor: __________________________ Date __________________
(3) Company Contact Person: _____________________________ Date __________________
(4) Department Chair: ___________________________________ Date __________________
(5) Registrar’s Office: ____________________________________ Date __________________
Registrar’s Office will enroll student in Internship only after all signatures are obtained.
INTERNSHIP PRECONDITION CHECKLIST:
Conditions must be met before form is signed.
1) Student has no incomplete grades on their transcript.
2) Student has no other internships this semester.
3) Student will have no more than nine credit hours of internships at graduation.
4) Student meets department criteria for G.P.A. and required curriculum.
5) List of specific learning objectives is attached to this form.
6) Signed statement is attached indicating how internship will be assessed and dates when
faculty supervisor will make on-site visit(s). Both faculty and company rep must
complete a performance evaluation.
7) Plan must include a minimum of 50 clock hours of work experience for each credit
Internship Company Name: ________________________________________________________________
Company Address: _______________________________________________________________________
Name of Contact Person: ____________________________ Business E-Mail: _____________________
Title: _____________________________________________ Business Phone: _____________________