Massachusetts College of Liberal Arts
                               Internship Application



Student                                                        
Name:_________________________________    SS# Number:______-____-_______

Address:______________________________    Telephone Number:________________

Major:____________      Class Year:______  Cumulative GPA:_________________
(Must be Jr. or Sr.)                       (Must be 2.0 or Higher)

Has the student received any prior Internship Credit at Massachusetts College
of Liberal Arts? No ____ Yes ____ If yes, how much credit was earned?________

Title of internship:________________________________________________________.

Name and address of organization at which internship will be completed:

____________________________________________________________________________

Name of faculty sponsor:______________________Telephone Number:_____________

Name of on-site supervisor:_________________Telephone Number:_______________

In what academic department or discipline will credit be granted? ____________

Inclusive dates of internship:________________ To ________________.

Number of on-site hours per week ________Total number of on-site
hours:________

Number of credits approved (provide credit equivalent for on-site hours e.g. 9
hours on-site = 3 credits):____________________

Term in which credit is to be granted:______________    YEAR:__________

Method of grading: LetterGrade(A,B,C,D,F)Pass/Fail  ___________________

1. List the education and experiential objectives of the internship:







2. Specify the on-site work and responsibilities to be undertaken during this
   internship:







3. How will the student's achievements of the education and experiential  
   objectives be evaluated by the faculty sponsor and by the on-site
supervisor.
   Please be specific:






4. Provide any information which supports the student's preparedness to   
   successfully complete this internship:





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Student's Signature:______________________________   Date:_____________

Faculty Sponsor's Signature:______________________   Date:_____________

This signature indicates that the faculty sponsor has interviewed the student
and is recommending them for this internship.

Department Chairperson:_____________________________ Date:____________

Dean of Academic Studies:   ________________________ Date:____________

NOTE:  This form must be completed and submitted to the Career Services
Center, Bowman Hall, Suites 19-122, no later than the last day of the 
drop/add period for the term in which credit will be granted.