Internship Contract
Department of Communication Arts
Valdosta State University

E-Mail __________________________   Date ____/____/____

Name ________________________________   Student ID 870- ______________________

Local Address:

Street ___________________________   Phone ( ) __________________

City ______________________________   State ____   ZIP _____________

Permanent Address:

Street ___________________________   Phone ( ) __________________

City ______________________________   State ____   ZIP _____________

Date of Anticipated Graduation: ____________________________

Communication Emphasis: ___________________________________

Proposed Internship Term:   Fall   Spring   Summer   Year ___________

Credit Hours for Internship:   3   6   9

Internship Information:

Agency/Organization: ___________________________________________________________

Director/Manager: ___________________________________________

Your Supervisor: _____________________________________________

Address: ________________________________________________________

City ___________________________   State ________   ZIP _____________

Phone ( ) ______________________   FAX ( )______________________

E-mail: ________________________________________________________

INTERNSHIP CONTRACT, p. 2

Description of Internship: (Attach Job Description if Available)

Signatures:

Intern _____________________________________________________________

Director at Host Organization __________________________________________

Academic Advisor ___________________________________________________

Submit contract to Dr. Patterson for following signatures

Department Head ___________________________________________________

Intern Coordinator __________________________________________________