Application for Internship Credit

I have read and agree to the instructions found below. Please note the cumulative hours earned and GPA requirements.*

I Agree

Students who do not meet eligibility requirements need to contact the Academic Dean academicaffairs@wvwc.edu

By checking this box, I understand that under no circumstances should I begin an internship until all necessary approvals are secured, the internship is officially approved and I have completed the registration process . Once the internship has been approved by ALL appropriate parties (faculty sponsor, site supervisor, academic unit leader, Director of Experiential Learning, Registrar), and I receive confirmation, and officially register, I may begin my internship hours.**

I Agree

STUDENT INFORMATION

Title of Internship*

Please note that this will appear on your transcript

Contract Period From*

Date

To*

Date

Based upon the dates entered the internship credit will be placed in the corresponding enrollment term

Student Name*

First NameLast Name

Student ID*

Student WVWC Email*

username@wvwc.edu

Are you an international student?*

Cumulative Hours Earned*

Must have completed at least 30

Cumulative GPA*

Must have a minimum 2.5

Major(s)*

Minor(s)

Campus Box #*

Cell Phone Number*

Mailing Address During Internship Period (if you live off campus)

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

INTERNSHIP PLACEMENT

Name of Company or Agency*

Email of Company or Agency (other than supervisor)*

example: info@company.com

Fax Number of Company or Agency

Address of Company or Agency*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Site Supervisor Name*

First NameLast Name

Site Supervisor Email*

Confirmation Emailplease ask supervisor if you are not 100% certain

Site Supervisor Phone Number*

Faculty Sponsor Name*

First NameLast Name

Faculty Sponsor Email*

username@wvwc.edu - must be accurate

School Director / Department Chair Name OLD*

First NameLast Name

School Director / Department Chair Name*

School Director / Department Chair Email*

username@wvwc.edu

SD Checker

Experiential Learning Coordinator Name

Email

Academic Services Registrar Name

Email

ACADEMIC RECORD AND CREDIT INFORMATION

Credits to be Earned*

Indicate course level*

Course Prefix*

Course number*

Academic Level*

Note: Failure to indicate appropriate course number may result in credit not aligning with preferred course. Consult with faculty sponsor to ensure correct code. If you have questions regarding the appropriate course number please contact the Registrar's Office registrar@wvwc.edu

I wish these hours of internship to be applied to my academic record as credits in*

MajorMinorExploratory (outside major/minor - three hour limit)