Approval Form for Interns

______________________________________ has shown interest in an internship for the ________ Semester, 20_______.

Approval of the following persons is necessary before this student can register for Internship credit.

Please check which of the following intern courses the student is seeking to register for:

______ Internship INTN 4920A (for-profit agencies)

______ Georgia Internship INTN 4920B (non-profit agencies)

______ Legislative Internship INTN 4920C (only in Spring semester when Georgia General Assembly is in session)

______ Governor's Internship INTN 4920D (state or non-profit agency; must apply to Governor's Internship program in Atlanta)

Placement

Agency_________________________________________________________________________________

Address_________________________________________________________________________________

Printed Name of Agency Supervisor___________________________________________________________

Position of Supervisor______________________________________________________________________

Phone & E-mail___________________________________________________________________________

Signature of Agency Supervisor___________________________________________Date ________________

Note: In addition to signing this form, the agency supervisor must provide a letter of intent verifying agreement to the internship and detailing the interns duties, hours, pay (if any), name of supervisor, etc.

Approvals

(This is to be signed by each of the following persons prior to registering for Intern credit)

Academic Advisor____________________________________________ Date__________________________

Department Chair______________________________________________ Date_________________________

Faculty Supervisor_____________________________________________ Date_________________________

Internship Coordinator______________________________________________ Date________________________