Internship Application Form Please complete the following information to begin your application process to enroll in Department of Communication internship course credit hours. First Name Last Name Email Current Address Current Address City/Town State/Province - None -AlabamaAlaskaAmerican SamoaArizonaArkansasArmed Forces (Canada, Europe, Africa, or Middle East)Armed Forces AmericasArmed Forces PacificCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFederated States of MicronesiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarshall IslandsMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPalauPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirgin IslandsVirginiaWashingtonWest VirginiaWisconsinWyoming ZIP/Postal Code Current Phone Semester of intended Internship Intended credit hours (1-3) Have you been admitted to the major? - None -YesNo Date of admission Expected Graduation Date Current GPA Please list all of the communication courses you have completed or are currently taking. Please include the semester of the course. If the course has been completed, please include the grade received.? Please list all of the communication courses you have completed or are currently taking. Please include the semester of the course. If the course has been completed, please include the grade received. Please list all of the communication courses you have completed or are currently taking. Please include the semester of the course. If the course has been completed, please include the grade received.? Please list all of the communication courses you have completed or are currently taking. Please include the semester of the course. If the course has been completed, please include the grade received.? Please list all of the communication courses you have completed or are currently taking. Please include the semester of the course. If the course has been completed, please include the grade received.? Please list all of the communication courses you have completed or are currently taking. Please include the semester of the course. If the course has been completed, please include the grade received.? Please list all of the communication courses you have completed or are currently taking. Please include the semester of the course. If the course has been completed, please include the grade received.? Communication Courses/Semester/Grade Internship Agency Business Address Address Address 2 City/Town State/Province - None -AlabamaAlaskaAmerican SamoaArizonaArkansasArmed Forces (Canada, Europe, Africa, or Middle East)Armed Forces AmericasArmed Forces PacificCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFederated States of MicronesiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarshall IslandsMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPalauPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirgin IslandsVirginiaWashingtonWest VirginiaWisconsinWyoming ZIP/Postal Code Business Phone Contact Person + Title Contact Person Email How did you hear about this internship? Describe your job’s tasks and responsibilities Describe why this internship is a good fit for you and what communication skills/knowledge you will be applying in this internship List the learning objectives/goals you expect to complete during your internship (e.g. skill development, broader knowledge, career awareness, personal development, networking, etc.) I understand that by signing this form: I agree to represent the Department of Communication to the best of my abilities, agree to carry out my job’s tasks and responsibilities, and agree to meet my learning objectives and goals. Please Sign Above Date Please make sure that your permanent address and phone number are on file in the main office.