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Student Application for Internship

Name: ___________________________________________________ Date: ___________________
Last First M.I.

Social Security Number (optional): ______________________________________________________

School Address: _______________________________________ Telephone: ( )________________

________________________________________

School Email Address: ___________________________________

Home Address: ________________________________________ Telephone: ( )________________

Home E -mail Address: ____________________________________

Citizenship Status (check one): ____ U.S. ____ Permanent Residen t ____ Student Visa

Emergency Contact Information: __________________________________________________________

Relationship: __________________________________________________________________________

Address: _____________________________________________________________________________

University or College: ___________________________________________________________________

Major: ___________________________________ Minor: __________________________________ ____

Year in School: ______________________ GPA: _______ Expected Date of Graduation: ______________

Present and Past Work Experience (include paid and volunteer)

From/To Employer Description of Duties

_____________________________________________________________________________________ _____

__________________________________________________________________________________________

________________________________________________________________________ __________________

Computer Skills: ____________________________________________________________________________ _

Student Application for Internship (continued)

Other Skills/Abilities/Interests: __________________________________________________________ _______

_________________________________________________________________

_________________________________________________________________

What foreign language do you speak fluently and understand? _______________________________________

__________________________________________________________________________________________

When are you available to start a work -study/internship? ___________________________________________

_____________________ _____________________________________________________________________

Approximate hours per week: _________________________________________________________________

Geographic limitations/preference for internship: ________________________________________ _________

What are your objectives for participating in an internship program? ___ _______________________________

__________________________________________________________________________________________

What kinds of work would you like to do during y our internship? _____________________________________

Internship preference: _________________ Generalist: _____________ Specialist: area of interest __________

If a stipend is not offered, would you be able to accept an internship on a volunteer basis? ________________

__________________________________________________________________________________________

What, if any, physical limitations do you have that may have a bearing on your placement? ________________

______________________________________ ____________________________________________________

Do you have a valid driver’s license and access to a motor vehicle? ____ Yes ____ No

License only: ________________ ____

Student Letter of Reference

STUDENT INTERNSHIP COORDINATOR

Name: __________________________________________ Name: ____________________________________

Address: _________________________________________ Company: ________________________________

_________________________________________ Address: _______ __________________________

Degree: _________________________________________ _ _________________________________

Major: ___________________________________________ __________________________________

The student noted abov e has requested that you provide a letter of reference to the abovementioned
internship coordinator as part of the requirements for obtaining an internship during the next semester. You
may complete a sign this form or attach a personal letter of reference , if you prefer. This letter of reference
should be completed and returned by
1. How well did you know the student? (please circle on)
Very well Limited knowledge Not very well
2. In what capacity did you know the student? (check all that apply)
___ Served as student’s instructor
___ Served as the student’s faculty advisor
___ Worked together on a project
___ Know personally outside of class

3. Please rate the student on the following factors on a scale from 1 to 5. (1 = poor; 5 = excellent)
Scholarship 1 2 3 4 5
Initiative 1 2 3 4 5
Leadership 1 2 3 4 5
Dependability 1 2 3 4 5
Judgment 1 2 3 4 5
Verbal communication skills 1 2 3 4 5
Written communication skills 1 2 3 4 5
Potential for development 1 2 3 4 5
EVALUATOR

Name ______________________ ___________________ Position _____________________________________

Address: ___________________________________________________________________________________

Organization Position Requirement Form

Organization: _________________________________________ ______________________________________

Address: ___________________________________________________________ Zip Code: _______________

Contact Person

Name: ____________________________________________ Title: ___________________________________

Address: ___________________________________________________________________________________

Telephone: ( )____________________________________________________ Extension: _____________

Email Address: _____________________________________________________ _________________________

Number of students you would to have for internships: _____________________________________________
(Please fill out a separate position description for each different job)

List titles of interns: _______________________________ ___________________________________________

__________________________________________________________________________________________

Description of Organization (Attach annual report if available):

_____________________________________________________ _____________________________________

__________________________________________________________________________________________

__________________________________________________________________________________________

Benefits available to Interns (At tach description booklet if available):

__________________________________________________________________________________________

__________________________________________________________________________________________

_______________________________ ___________________________________________________________

How do you want to sеlесtyour candidate?: ___ Organization interview ___ University decision
If employer interview is selected, list date you would like to begin: ____________________________________
Who will notify student of acceptance? ___ Organization ___ University

Internship Position Description Form

Company Name: ____________________________________________________________________________

Position title: _______________________________________________________________________________

Supervisor: _____________________________________________________ Title: _______________________

Address: ____________________________________________________________________ _______________

Telephone: ( )___________________________________________ Extension: _______________________

Email address: ______________________________________________________________________________

Position Description (List duties, responsibilities, etc.):

__________________________________________________________________________________________

__________________________________________________________________________________________

______________________________________________ ____________________________________________

__________________________________________________________________________________________

Qualification/Requirements (i.e., education, technical skills):

__________________________________________________________________________________________

__________________________________________________________________________________________

________________________________________________________________________ __________________

__________________________________________________________________________________________

Starting date: _______________________________ Anticipate duration: ______________________________

Intern status: ___ Full time ___ Part time Hours per week: ________________________

Pay status: ___ Nonpaid/volunteer ___ Paid $ _______________ per __________________

Work schedule: ___ Varied based on student schedule
___ Fixed as follows: ________________________________________ _________________

Internship Agreement of Responsibilities

Student Intern: As the student enters the company, he or she is expected to assume, as much as possible, the
role of a regular staff member. The responsibilities include :
1. Adhering to company work hours, policies, procedures and rules governing professional staff behavior.
2. Adhering to company policies governing the observation of confidentiality and the handling of confidential
information.
3. Assuming personal and professional responsibilities for h is or her actions and activities.
4. Maintaining professional relationships with company employees, customers and so forth.
5. Utilizing a courteous, enthusiastic, open -minded, critical approach to policies and procedures within the
profession.
6. Relating and app lying knowledge acquired in the academic setting to the company setting.
7. Developing self -awareness in regard to attitudes, values, behavior patterns and so forth that influence work.
8. Preparing for and utilizing conferences and other opportunities of learning afforded in the company.
9. Being consistent and punctual in the submission of all work assignments to the supervisor and faculty
coordinator.
10. Providing the faculty coordinator with periodic progress reports.
AGREED: _________________________________ _________________________________________________
Student Signature

Organization: It is the responsibility of the employer to provide direct on -the -job supervision of the student
intern that includes the following:
1. Orienting the student intern to company’s structure and operation.
2. Orienting the student intern to the company’s policies and procedures regarding appropriate dress, office hours
and applicable leave policies.
3. Introducing the student intern to the appropriate professional and clerical st aff.
4. Providing the student intern with adequate resources necessary to accomplish job objectives.
5. Orienting the student intern to the policies and procedures of the personnel department.
6. Affording the student intern the opportunity to identify with the sup ervisor as a professional staff person by
jointly participating in office interviews, meetings, conferences, projects, and other personnel and management
functions.
7. Assigning and supervising the completion of tasks and responsibilities that consistent with the student intern’s
role in the company.
8. Consulting the faculty coordinator in the event that the supervisor becomes aware of personal, communication
or other problems that are disrupting the student intern’s learning and performance.
9. Providing regularly scheduled supervisory conferences with the student intern.
10. Participating in joint and individual conferences with the student intern and faculty coordinator regarding the
student intern’s performance.
11. Submitting an evaluation on the student intern’s job p erformance.
12. Submitting a job description for the student inter by _________________________________________
Date
AGREED: __________________________________________________________________________________
Supervisor Signature

Internship Agreement of Responsibilities (continued)

Faculty Coordinator: The faculty coordinator assumes overall responsibility for consultation with the company
and interns on objectives, agreements and other job -related tasks. The faculty coordinator is available to the
student in an advisory capacity wit h respect to assisting the student intern to achieve the state objective of the
internship. The role of the faculty coordinator involves:

1. Conducting an individual preplacement orientation and introducing the student intern to the nature and purpose
of th e internship.
2. Orienting and introducing the company supervisor to the purpose and objectives of the internship.
3. Consulting with the company supervisor and student intern on a regular basis regarding the student intern’s
performance.
4. Assuming responsibility for the removal of a student intern from the internship setting, whenever necessary.

AGREED: __________________________________________________________________________________
Faculty Coordinator Signature

Model Internship Program
Internship Agreement
Student Intern Organization’s Supervisor Faculty Coordinator
Name
Address
Phone

This letter of agreement confirms the responsibilities of the organization, the student intern and the faculty
coordinator in the internship, the beginning and ending dates of the internship, and the due dates for the
performance evaluations. This agreemen t will be provided to the company prior to the student reporting to
the organization.

The variety in the size of the organization participating in the internship may, in some cases, require slight
modifications of the procedures contained in the guidelin es. Significant modification of these procedures
should be mutually approved and signed by all o f the parties who are part of the original agreement.

Beginning date of internship: __________________________________________________________________

Completion date of internship: _________________________________________________________________

Will the intern be paid? ___ Yes ___ No

If yes, how much? $ _______________ Per _________________

Will the intern receive college credit for internship? ___ Yes ___ No

If yes, how many credits? ______________________________

Interns weekly work schedule: _________________________________________________________________

____________________________________________________________________________________ ______

Position: ___________________________________________________________________________________

Location of organization work assignment: _______________________________________________________
The organization is under no obligation to offer full -time employment to student prior or after graduation. Likewise, the student is under no obligation
to the organization after completion of the prescribed work period(s) for an internship.

Organization Evaluation Form
Students may use this form to evaluate their internship experience.

Internship Evaluation Form

Student: ________________________________________________________ Date: _____________________

Organization (Name and address): ______________________________________________________________

______________________________________________________________

______________________________________________________________

A. Rating of Organization Characteristics
Rate the employer based on the characteristics listed below. Check the appropriate space.
Characteristics Excellent Above Average Average Below Average Poor Not Applicable
Ability to teach
Ability to supervise and mentor
Willingness to provide guidance
Relationship with other
employees

Courtesy/respect
Leadership skills
Interpersonal skills
Communication skills
Technical competence
Business skills
1. Did you feel the work was a valuable experience in relation to your academic studie s?

2. Were you given responsibilities that enabled you to apply knowledge and skills?


3. Were you allowed to take initiative to work beyond the basic requirements of the job?


4. Did the organization and/or supervisor work with you regularly? Were they available to answer
questions when necessary?

Organization Evaluation Form (continued)

5. Briefly note new skills, techniques and knowledge gained in this position.




6. Discuss the weak points of your internship experience and ways they may be improved.




7. Discuss the strong p oints of your internship experience




8. Is there anything that was not covered that should have been covered in the internship training
program?




9. Do you think your academic program adequately prepared you for this internship?




10. If you have any aspect of your internship to do over, what changes would you make?


11. Would you recommend this internship to other students? Explain.




12. Note any comments about your particular job not covered above.

Intern Evaluation Form

Student: ____________________________ _____________________________ Date: ____________________

A. Rating of Intern Characteristics
Rate the intern based on the characteristics listed below by checking the appropriate space. Record instances in which the st udent
made noticeable improvements on any characteristic during the program. For longer internship placements (six months to a year), it
may be advisable to do a midterm evaluation and an end -of-term final evaluation in order to track the intern’s improvement.

Characteristics Excellent Above Average Average Below Average Poor
Punctuality
Willingness to learn
Creativity (problem solving)
Ethical behavior
Dependability
Thoroughness (attention to detail)
Teamwork
Work speed
Ability to supervise
Interpersonal skills
Communication skills (oral)
Communication skills (written)
Technical competence
Managerial potential
Judgment
Adaptable to variety of jobs
Accepts constructive criticism
Ability to work independently
Accepts responsibility
Professionalism
Overall skills for industry

B. Performance Assessment

1. How well was the intern prepared for this internship?

2. Can you suggest instructional areas which would benefit this intern?

3. What professional characteristics did you like most about this intern?



4. What professional characteristics did you think the intern lack?

Intern Evaluation Form (continued)
5. Please provide examples in which the intern applied good judgment and had a technical competence
for the assigned tasks.

6. How would you rate the intern’s sense of duty or responsibility toward his or her assignment(s)?


7. Please provide some examples in which the intern worked quickly, thoroughly, and/or efficiently?

8. What are t he intern’s strengths and weaknesses when interacting with others ?


9. What are the intern’s strengths and weaknesses in oral and written communication ?

10. What are the intern’s strengths and weaknesses when it comes to leadership skills?


11. In what areas does the intern need improvement?

12. Discuss areas where the intern has made significant improvement.


13. What kind of training or orientation did you provide before the student began working?

14. Would you recommend this intern for future employment in the human reso urce profession? Why or
why not?


15. Are there any other areas involving the internship program and/or the intern on which you wish to
comment?
Signature: _______________________________________________________ Date: _____________________
Company Name and Ad dress: __________________________________________________________________
__________________________________________________________________________________________