Print Email Share Tweet Student’s Name: SE ID (S0#######): Option in Major: Total Hours Completed Total Hours Completed in Option Sequence Campus Address Campus Phone Cooperating Agency Information Company Name Company Address Supervisor Resume on File Title Phone Number Internship/Practicum Title for Permanent Records Starting Date of Internship/Practicum Closing Date of Internship/Practicum Number of Weeks of Internship/Practicum List of Internship/Practicum Work Tasks: Additional Requirements to be fulfilled before credit is granted for internship/practicum: Weekly Time Log to be submitted via email at the end of each weekly period as shown on Sample Logs link, totaling 180 hours worth of work Two on-job work samples representing the internship/practicum (can be in draft form). Supervisor’s Internship/Practicum Performance Review Form Self & Program Evaluation Form All materials and information submitted for your Internship/Practicum become property of the Department of Mass Media to be maintained in the Resource Room. These items cannot be returned Student’s Signature _______________________________ Date _________________ Company Representative’s Signature _______________________________ Date _________________ Internship/Practicum Coordinator's Signature _______________________________ Date _________________ Department Chair’s Signature _______________________________ Date _________________ News Calendar Current TodayPlease Enable JavaScript.
