Internship Site Verification Form
Fall 20 __ __ Spring 20 __ __ Summer 20 __ __
Instructions for the Student Submit the following documents to your Internship Coordinator:
1. Student Information / Internship Site Information & Internship Qualifying Questions [Page 1 & 2 of this form]
2. Resume used to obtain Internship Position.
3. Acceptance Letter [Copy of correspondence or email from company/supervisor offering the position.]
4. Job Description for Internship Position from the internship site.
5. Internship Questions: [type question followed by your response as 1-page response in Word doc format]
A. Why did you select this specific internship opportunity?
B. How will this experience affect your overall career aspirations?
C. What do you hope to gain from this internship opportunity?
Today’s Date: ____ / ____ / ____
ID #: ___ ___ ___ ___ ___ ___ ___ ___ ___ ___
Address during Internship:
City / State / ZIP:
Phone #: ( )
Major: Year in School (circle): Soph Junior Senior
GPA: Credit Hours Completed: Anticipated Graduation:
This would be my: (circle one) 1st 2nd 3rd internship. Previous Internship @:
Start Date: Anticipated End Date:
Intern Position/Title: Internship Type (circle): PAID [$_______ ] / UNPAID
Internship Credits: Total Credits for Semester:
Internship Site Information
Company/Business Name: Supervisor’s Name:
Address : Supervisor’s E-mail:
City/State: Supervisor’s Title:
ZIP: Supervisor’s Phone :
Company Website: Supervisor’s Fax:
Complete Page 2 ----- >
Office Use: ___ SoHE major verification ___ Orientation Meeting confirmed ___ Permission to Enroll given
& Transcript Review ___ Database Entry 2012-2013 ___ Confirmation email sent
Student Academic Affairs & Career Services / 1194 Nancy Nicholas Hall / Phone: (608).262-2608 / Fax: (608).262-3616 / www.sohe.wisc.edu Page 1
Internship Qualifying Questions
Your internship documents will be reviewed to ensure a quality experience. Only content-appropriate internships that
coincide with the objectives of one of the 8 School of Human Ecology majors will be approved for credit.
Using the company’s job description, compare the following list of departmental standards for an internship to help you
determine the value of your own internship with the opportunity being offered by the business/company/agency.
THIS IS FOR STUDENTS TO COMPLETE, and is to be shared with INTERNSHIP SITE.
[Circle OR BOLD] Please read through each statement for an overview of academic expectations for an internship.
Yes No This internship is NOT with a company owned by your parents or relatives and/or your
supervisor is NOT your parent or relative
Yes No This internship directly relates to your major and or overall career goal
Yes No You will be assigned an independent project for which you are responsible
Yes No You will be responsible for completing daily/weekly duties at your internship site
Yes No To receive academic credit, you must complete the required number of hours determined by
the department in which you are enrolled for the course (please verify with internship coordinator
the required number of hours you will need to complete)
Yes No The academic coursework required for this course will be completed during the semester in
which you are enrolled in the internship course
Yes No There is a supervisor/mentor assigned to work with you to whom you directly report
(this not a relative)
Yes No There is a training period in which you will be briefed on company policy and your role and
job responsibilities as an intern
Yes No Clerical work (data entry, copying, filing, stuffing envelopes, answering phones, cold-calling)
is limited during your internship
Yes No This is not “job shadowing” managers or simply observing other co-workers
Yes No The company will provide you with a job description which clearly explains your duties
I, the undersigned student, verify the above information regarding my internship is true to the best of my knowledge and
I have compared the qualifications with a company job description. By signing this form, the student agrees to work
professionally and ethically in completing both the on-site internship and the online course assignments.
Student Name (PRINT):
Student Signature: Date:
If your internship meets all of the above requirements, submit your Internship documents to your internship coordinator :
Mary Braucht: firstname.lastname@example.org (608) 265-3572 Jayme Porteus: email@example.com (608) 265-6467
(Consumer Affairs / Personal Finance / Retail) (Human Development & Family Studies)
(Interior Design / Textile & Apparel Design) (Community & Nonprofit Leadership)
Student Academic Affairs & Career Services / 1194 Nancy Nicholas Hall / Phone: (608).262-2608 / Fax: (608).262-3616 / www.sohe.wisc.edu Page 2