Application for Credit for ID 495
Environmental Studies Internship

Student Information:

Name: ____________________________ Phone: ______________

Major: ____________________________ E-mail: ______@evansville.edu

Classification of student: (please circle response)
Freshman         Sophomore         Junior         Senior

Internship Information:

Facility: _______________________________________________________

Location: ______________________________________________________

Major activity of facility: _________________________________________

Your supervisor: ________________________________________________

Supervisor's address: _____________________________________________

_______________________________________________________________

Supervisor's phone: ______________________________________________

List and describe the types of activities in which you will be involved (continue on back):

This internship will take place during: (please circle response)
Summer         Fall         Spring

Year: ______

Hours per week:

What other courses will you be taking at the same time as the internship?

Credit hours requested (3-8): _____ (note any special circumstances on back)

Semester and year when credit hours will be taken: __________________________

(note: credit hours may be taken during the Fall semester following a Summer internship)

Student signature __________________________ Date ____________

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To be Filled out by the Director of the Program

Approved ________ Date __________ Report submitted __________ Grade ______