HUMAN SERVICES GRADUATE INTERNSHIP APPLICATION

We require you to provide the needed information for your internship approval request.

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Student Name Student Name * First Last
E Number *
Enter your EIU/Panther Email, or your request will not be processed. *
Phone Number Phone Number * - ### - ### ####
Semester of Enrollment: *
Number of semester hours you would like to earn for this course (note: this should be determined in consultation with your academic adviser) *
How many hours a week will you work? (must be determined with your site supervisor, keeping in mind EIUs schedule and the number of internship hours required) *
Internship Site *
Internship Site Supervisor (If you do not know who will supervise you when on site, use the name of your current contact person) *
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Enter Your Email Address *

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