*ALL INFORMATION IS REQUIRED*

Your Name: ID Number:

Campus Phone Number: Permanent Phone Number:

E-mail Address:

School Mailing Address:

Permanent Mailing Address:

Who is your adviser:

# of Credits you want for the internship:

Are you certified?
Yes No

Which semester are you looking to do the internship in?
Spring Summer Fall

Are you in the Journalism sequence?
Yes No

Check the following courses you have taken or will have taken prior to doing the internship:
JOUR 330 JOUR 425 JOUR 305 COM 295

If you have not taken all the above courses see the following option:

COM 495-for qualified students who wish to intern at a non-newspaper site OR for students who have not completed JOUR 330 or JOUR 425 but wish to intern at a newspaper. Students must have at least a 2.7 GPA. (2-12 credits available).

JOUR 499-for qualified students who wish to gain newspaper experience but have not completed required coursework. SEE ROBERTA KELLY FOR REQUIRED APPLICATIONS.(1-3 credits available).

COM 499-for qualified students who wish to work at a non-newspaper site but have not completed the required coursework. SEE THE ASSOCIATE DIRECTOR OF UNDERGRADUATE STUDIES FOR REQUIRED APPLICATIONS.(1-3 credits available).

If you have found an internship already, please fill out the following:

Company Name:

Company Phone Number:

Company Mailing Address:

Supervisor's Name:

Supervisor's Phone Number:

Supervisor E-mail Address:

Fax Number:

Starting Date:

Ending Date:

I agree I will perform in a professional manner and will follow the instructions and policies of the organization where I will be interning. I understand that I will submit a written report describing my activities and evaluating my experience at the conclusion of my internship. This must be done in a satisfactory manner before credit will be granted. I must enroll for credit with WSU that corresponds with the number of hours I work, and if I drop or fail to pay tuition fees, I will be dismissed from the internship program and the on-site supervisor will be notified that I am no longer with WSU. My GPA (in Communication Courses) must be at least 2.7 to qualify for an internship.

If you agree, please type your name and date on the form and click the SUBMIT button.

Signature

Date

Submit the information OR
if the form will not submit, print it out and return it to the Internship Coordinator in Murrow East 227 .