Application for Internship Credit

Application for Internship Credit
I have read and agree to the instructions found below. Please note the cumulative hours earned and GPA requirements.
Internship Instructions

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.*
STUDENT INFORMATION
Title of Internship
Please note that this will appear on your transcript
Contract Period From

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
To

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
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
Format: (000) 000-0000.
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
Format: (000) 000-0000.
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
Format: (000) 000-0000.
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