Registration for Academic Credit

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1. Last Name

Last Name

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2. First Name

First Name

3. Middle Initial

Middle Initial

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4. ID#

ID#

5. Address (during work experience)

Address (during work experience)

6. City

City

7. State

State

8. Zip

Zip

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9. Phone

Phone

10. Campus Address

Campus Address

11. Campus Phone

Campus Phone

12. Cell Phone (be sure to include area code)

Cell Phone (be sure to include area code)

13. Campus Box #

Campus Box #

14. Email (other than campus mail - e.g., Gmail or Hotmail)

Email (other than campus mail - e.g., Gmail or Hotmail)

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15. Date of Graduation

Date of Graduation

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16. Major

Major

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17. Academic Advisor (last name, first name)

Academic Advisor (last name, first name)

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18. GPA (Go to MCSquare and look in DegreeWorks or your unofficial grade report. Copy and paste into Word the page which verifies your GPA. Email that to the Internship Center - internctr@messiah.edu)

GPA (Go to MCSquare and look in DegreeWorks or your unofficial grade report. Copy and paste into Word the page which verifies your GPA. Email that to the Internship Center - internctr@messiah.edu)

*

19. I am registering for:

I am registering for:

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20. Internships are a letter-graded (A-F) class and are calculated into your GPA.

Grantham students - Internship Classes, both INT394 and INT395, meet on Tuesday from 5:30-7:30 p.m.

Summer students - Only INT394 credits are available. A Pre and Post-Summer class will be scheduled.

Film students - you may not register UNTIL you have an acceptance/approval email from Prof. Reid Perkins-Buzo and have forwarded it to the Internship Center.

Course Registration
- INT394 Monthly Class
- INT395 Weekly Class

Internships are a letter-graded (A-F) class and are calculated into your GPA. Grantham students - Internship Classes, both INT394 and INT395, meet on Tuesday from 5:30-7:30 p.m. Summer students - Only INT394 credits are available. A Pre and Post-Summer class will be scheduled. Film students - you may not register UNTIL you have an acceptance/approval email from Prof. Reid Perkins-Buzo and have forwarded it to the Internship Center. Course Registration - INT394 Monthly Class - INT395 Weekly Class INT394 - Monthly Class - 4 credits - minimum 10 hours/week for 12 weeks

INT394 - Monthly Class - 5 credits - minimum 15 hours/week for 12 weeks

INT394 - Monthly Class - 6 credits - minimum 20 hours/week for 12 weeks

INT394 - Monthly Class - 7 credits - minimum 25 hours/week for 12 weeks

INT394 - Monthly Class - 8 credits - minimum 30 hours/week for 12 weeks

INT394 - Monthly Class - 9 credits - minimum 35 hours/week for 12 weeks

INT394 - Monthly Class - 10 credits - minimum 40 hours/week for 12 weeks

INT395 - Weekly Class - 6 credits - minimum 10 hours/week for 12 weeks

INT395 - Weekly Class - 7 credits - minimum 15 hours/week for 12 weeks

INT395 - Weekly Class - 8 credits - minimum 20 hours/week for 12 weeks

INT395 - Weekly Class - 9 credits - minimum 25 hours/week for 12 weeks

INT395 - Weekly Class - 10 credits - minimum 30 hours/week for 12 weeks

INT395 - Weekly Class - 11 credits - minimum 35 hours/week for 12 weeks

INT395 - Weekly Class - 12 credits - minimum 40 hours/week for 12 weeks

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21. Name of Organization

Name of Organization

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22. Organization Address

Organization Address

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23. Organization City

Organization City

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24. Organization State

Organization State

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25. Organization Zip

Organization Zip

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26. Organization Supervisor

Organization Supervisor

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27. Supervisor Title

Supervisor Title

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28. Supervisor Phone

Supervisor Phone

29. Supervisor Fax

Supervisor Fax

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30. Supervisor Email (we must have a valid email address)

Supervisor Email (we must have a valid email address)

31. Organization Website

Organization Website

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32. Your Position Title (do not type "Intern" - e.g., Research Assistant, Editorial Assistant, etc.)

Your Position Title (do not type "Intern" - e.g., Research Assistant, Editorial Assistant, etc.)

33. Compensation (How much will you be paid per hour? If you are not being paid, type "0")

Compensation (How much will you be paid per hour? If you are not being paid, type "0")

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34. Hours per week (minimum is 10)

Hours per week (minimum is 10)

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35. Start Date (e.g. - 9/12/06)

Start Date (e.g. - 9/12/06)

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36. End Date (e.g. - 12/7/06)

End Date (e.g. - 12/7/06)

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37. Total Weeks (12 weeks minimum)

Total Weeks (12 weeks minimum)

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38. Job Description (what will you be doing at this site?)

Job Description (what will you be doing at this site?)

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39. Learning Objectives (list at least two skills or competencies you would like to develop during this experience)

Learning Objectives (list at least two skills or competencies you would like to develop during this experience)

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40. Approval
By selecting "Yes" below you affirm, and agree to, the "Guidelines and Policies" and the "Student Internship Agreement" as shown in the student information section of the Internship Center webpages.

Approval By selecting "Yes" below you affirm, and agree to, the "Guidelines and Policies" and the "Student Internship Agreement" as shown in the student information section of the Internship Center webpages. Yes

No

1) Your academic advisor will be notified by email for their approval of this learning experience.
2) An email will be sent to the Registrar's Office to register you for the credit option you have chosen above.
3) When finished, click the "Submit" button.

------------ For Internship Center Use Only ------------

Date / Time Received _________________________

Initials of Person Entering Data _________

Date Registrar Emailed ___________________