LONGWOOD UNIVERSITY

DEPARTMENT OF SOCIOLOGY, ANTHROPOLOGY AND

CRIMINAL JUSTICE STUDIES

Application for Internship

Name:____________________________________________________________________

Address:__________________________________________________________________

                        (Street)                                                                         (Apt. #)

              __________________________________________________________________

                        (City or county)                                        (State)                   (Zipcode)

Telephone: _______________________________Email:___________________________

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Internship Location Requested:_________________________________________________ 

Number of credit hours desired for internship (3-15 credits):________

Cumulative Grade Point Average (Note:  must be minimum of 2.5 to qualify for internship):________

Semester of Internship: ___________________________ 

Note:  This application must be completed and returned to the internship supervisor before you can be advised and enrolled in an internship. 

_____________________________________________

Approved    (Internship Supervisor)

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For Department Chair Only: 

Date Student Enrolled in Internship:______________

_____________________________________________

                        Approved (Department Chair)