Undergraduate Internship Arrangement

School of Psychology, Florida Tech

Two ways to use this form: (1) print then hand write form; (2) type in the fields, then print and sign. Note: this is not an interactive web form; you cannot "submit" the form data over the internet.


Student, complete this portion:

Student name:
Student #:
Semester and year in which internship will be performed:
Semester and year in which the student will enrol in the internship course (PSY4411):
Internship site:
Address:

 

Supervisor, complete the remainder of the form:

Supervisor  
Name:
Phone:
FAX:
Email:

Description of student activities during internship:

What skills relevant to the student's educational goals will be learned in the internship?

In what manner, and how frequently, will the student receive supervision?

Signatures:

Student: ________________________________________________

Supervisor: _______________________________________________________

Undergraduate Advisor: __________________________________________________

Student: Submit this form to the Psychology Main Office, undergraduate secretary, not to your advisor.

School of Psychology, Florida Tech
150 W. University Blvd.
Melbourne, FL 32901

Phone: 674-8104
FAX 674-7105

Contact: William K. Gabrenya Jr., Chair, Undergraduate Programs gabrenya@fit.edu

Internship page