APPLICATION For BSAN MAJOR Internship Stetson University School of Business Administration Department of Decision and Information Sciences Student Internship Program Form #1 Name: ___________________________________ 800# ___________________________ Semester: _________________________________ Major: __________________________ Date Assignment Starts: _____________________ Length of Assignment: _____________ Name of Organization: ______________________ Student’s Job Title: ________________ Address: __________________________________ ________________________________ _________________________________________ Work Hours: _____________________ _________________________________________ Supervisor: ______________________ Telephone: ________________________________ Title: ___________________________ Describe in detail your internship assignment (attach additional sheets, if necessary). ____________________________________________________________________________________ ____________________________________________________________________________________ ____________________________________________________________________________________ ____________________________________________________________________________________ ____________________________________________________________________________________ ____________________________________________________________________________________ Benefits (How will this internship help you with your career goals? How does it relate to your academic study?) _____________________________________________________________________________ ____________________________________________________________________________________ ____________________________________________________________________________________ ____________________________________________________________________________________ ____________________________________________________________________________________ I am aware of all of TheDIS Internship requirements and procedures and further assure that this is an academic internship and not merely part time/full time employment _______________________________________ Student Intern _________________________________ Date _______________________________________ Immediate Supervisor _________________________________ Date I approve the consideration of this student’s participation in the internship described above. ______________________________________ Faculty Internship Advisor ________________________________ Date ______________________________________ DIS Department Chair ________________________________ Date 3