internship proposal by NoFEi7


									                                 Internship Proposal for Academic Credit
                             Deadline for submission to Office of Internships is April 5, 2013.
           Proposal must be typed. This is a MS Word document; fields within the tables will expand as needed.

1. Student Information
Name:                                                          ID#:
E-mail:                                                        Phone:
Class Level:                                                   Major:
Address:                                                       City/ST/Zip:

2. Internship Site and Supervisor
Provide complete, accurate information. This will be used for communication with your supervisor.
Organization Name:                                            Supervisor’s Name:
Address:                                                      Supervisor’s Title:
City/ST/Zip:                                                  Supervisor’s Phone:
Country:                                                      Supervisor’s E-mail:
Is this a non-profit organization? (yes or no)

3. Pay Status and Hours
Will the organization be paying you for this                   If yes, Amount per hour:
internship? (yes or no)                                                Amount of stipend:
                                                                       Other form:
Starting date:                                                 Ending date:
Hours per week:                                                Number of weeks:
Total hours:

4. Course Information
Dept and Course Number:                                        # of Course Credits:
Course Title:                                                  Term and Year:

5. Faculty Sponsors
                    Primary Faculty Sponsor                                    Secondary Faculty Sponsor
Name:                                                          Name:
Dept:                                                          Dept:
E-mail:                                                        E-mail:
Phone:                                                         Phone:

6. Describe your internship position briefly (functions, duties, projects, etc).

7. What are your learning objectives (specific, measureable, achievable) and personal goals for completing
this internship?

                                                 Office of Internships
                                        (859) 985-3656
               106 Draper Bldg., CPO 2136, Berea College, Center for Transformative Learning, Berea, KY 40404
                                                                                                           revised Jan 2012
8. What preparation have you had for this internship? (relevant courses, research, or work experience)

9. You are required to keep a reflective journal that makes the connection between your daily experiences
and learning. Your faculty sponsor may have specific guidelines or prompt questions for the journal.
What form will it take? How often will entries be made? When and how will it be submitted?

10. You are required to submit a final paper. Based on parameters specified by your primary faculty
sponsor, describe the assignment, including topic (if determined), format, spacing, length (typically 5-10
pages), etc. The paper is due by August 31, if enrolled in summer terms; or by the last day of classes, if
enrolled during fall or spring.

11. You are required to make an oral presentation. Specify when and to whom this presentation will be
given. For summer interns, this takes place sometime in the fall semester.

12. Optional/Additional: Describe any other assignments agreed upon with your Faculty Sponsor and/or
required by a specific major or internship program (i.e., an audition, portfolio, supplemental reading or

13. You are required to complete a Student Evaluation of your experience and submit it to the Office of
Internships. The evaluation form will be emailed to you at the end of August (for summer interns). Your
final grade will not be posted until the evaluation is received.

14. Specify percentages each assignment will carry in determining your grade.
Students enrolled in summer will receive a grade of “I” (incomplete) to accommodate on-campus presentations
during the fall semester. The “I” will be changed by the end of the fall semester.
Journal:                                Paper:                               Presentation:

Supervisor’s Evaluation:               Optional/Additional:                    Total: 100%
(not more than 15% of grade)

                                             Office of Internships
                                    (859) 985-3656
           106 Draper Bldg., CPO 2136, Berea College, Center for Transformative Learning, Berea, KY 40404
                                                                                                       revised Jan 2012
15. Funding

Are you requesting funding assistance from Berea College for this internship? (yes or no) :
If yes, complete the Internship Funding Request form and attach it to the proposal.

16. Approval

                                                     Approval Signature                                     Date

Primary Faculty Sponsor

Secondary Faculty

Academic Advisor

Academic Program

International Student
(if applicable)
                  If an approval signature cannot be obtained before the registration deadline,
          an e-mail stating approval may be sent directly from the individual to:

Please make an appointment with the Director of Internships to submit the finalized proposal with original
signatures prior to the DEADLINE of April 5, 2013 (for summer 2013). At that time, funding requests will be
reviewed, amounts and sources finalized, and you will be registered for the course. Internship courses may be
added up until the last day to add a class, if there are extenuating circumstances.

A copy of this finalized Internship Proposal will be sent to the internship site supervisor as an attachment to
the Internship Agreement. The Internship Agreement must be signed by the supervisor and student and
returned to the Berea College Office of Internships prior to the start of the internship (or immediately

                                                                     Approval Signature
Director of Internships

                                             Office of Internships
                                    (859) 985-3656
           106 Draper Bldg., CPO 2136, Berea College, Center for Transformative Learning, Berea, KY 40404
                                                                                                       revised Jan 2012

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