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Communication Arts

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Fulton School of Liberal Arts

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Student Groups, Advising, Internships & Practicum

Contact Information

Mrs. Patti Burton
(410) 543-6229
Fulton Hall 261
pnburton@salisbury.edu
Salisbury University
Salisbury, MD 21801

Application for Internship

Department of Communication and Theatre Arts
Salisbury University

PART I: (information on the intern)

Local Address and Phone Number

Name:

Student ID:

Phone# Area code & Number:

Street Address:

City:

State:

Zip Code:

Address and Phone numbers during Internship

Phone# during internship:

Street Address:

City:

State:

Zip Code:

Email:

Major - Four Letter Abbreviation:

Track/Minor:

Hours completed prior to internship:

GPA:

CMAT GPA:

Semester/Year during which you plan to take the internship:

Total hours during internship semester:

List previous CMAT classes that you believe help to qualify you for this internship:

CMAT #	Course Name	Hours

Relevant Professional Experience:

Give a statement of your professional goals and the reason for wanting to take this internship:

Describe how you found this internship and your connection, if any, with the organization or its employees:

PART II: (information on the organization)

Name of Organization:

Address:

City:

State:

Zip:

Name of On-Site Internship Supervisor:

Title:

Department:

Phone number:

e-mail address:

PART III: (information on the internship)

Student Job Title:

Date internship is to begin:

Date internship is to end:

Hours per week:

Total Hours for internship:

(48 hours per credit)

Units of Academic Credit to be Earned (3-6)

Work Schedule
Monday	Tuesday	Wednesday	Thursday	Friday


Is this internship salaried?
At what pay rate?

Are any expenses of the intern to be paid by the company?
Yes (If yes, please explain No

Explain:

Overall Nature of Work to be Performed by Student:

Describe in detail the assignments of the internship. Indicate % of time spent on each activity (to total 100%). This description will serve as the basis for final grading and assigning credit, so be as specific as possible.

Activity	Percent

Print the form before pressing the submit button

All four signatures are required for approval.

____________________________________________________ ___________

Intern Date

____________________________________________________ ___________

On-Site Internship Supervisor Date

____________________________________________________ ___________

CMAT Internship Director Date

____________________________________________________ ___________