Internship/Practicum Application Form

Please fill out this form if you would like to earn credit for an internship or practicum experience. Please fill out a new form for each internship/practicum for which you are applying.

Name * First Last
E# *
EIU Email *
Total Hours Completed *
Major Option/Concentration * Interpersonal Communication Corporate Communication Public Relations Communication, Society, and Popular Culture Mass Comm/ Electronic Media Production Mass comm/ Broadcast News
Cumulative GPA *

This can be found in your Degree Audit
CMN GPA *

This can be found in your Degree Audit
Requesting Credit For: * Internship (CMN 4275) Practicum (CMN 4375) Practical Experience (CMN 2375)
Credit Hours Requested (1-12 for 4275, 1-3 for 4375, 1 for 2375)
Semester * Fall Spring Summer
Year *
Supervisor Information
Supervisor Name * First Last
Supervisor Title/Company *
Supervisor Email Address *
Supervisor Phone Number * - (###) - ### ####
Short essay explaining why you are applying for this experience: *
Please explain why you feel qualified to earn credit for this experience: *

Internship/Practicum Application Form

Internship/Practicum Application Form

Supervisor Information