APPENDIX 4

INTERNSHIP APPROVAL FORM

Department of Philosophy

NOTE: The student must submit this form to the Director of Graduate Studies for approval at least one month before the end of the academic term before the internship is to begin.

Intern's Name:

Name of Organization:

Address of Organization:

Telephone of Organization:

Fax Number of Organization:

E-MAIL Address:

On-Site Supervisor's Name and Address: (attach letter of agreement)

Intern's Internship Residence and Telephone:

Internship Begins:

Internship Ends:

Description Duties and Philosophical Interest of Internship: (attach statement 500-1000 words).

On-Campus Supervisor: (member of Graduate Faculty)

Intern's Planned Interaction with On-Campus Supervisor during Internship:

(communication must be at least bi-weekly)

Specialized M.A. Program Internship ____________ Ph.D. Program Internship ______________

DATE: ______________

Student ______________________________________________________

On Campus Supervisor: _________________________________________