Student Academic Internship Site Request

Admin Info

Form category

Other

STUDENTS SHOULD ONLY SUBMIT THIS FORM AFTER MEETING WITH AND CONFIRMING PLACEMENT WITH THE AGENCY OR ORGANIZATION.

All students who wish to engage in academic internships at locations not listed on this site, must complete this Student Academic Internship Site Request form. This form will provide your potential site instructions via an email to start the application process to offer academic internships at CSUSM.

After submitting this form, please follow-up with your site contact to ensure they received the auto-email with the application link and encourage them to complete at their earliest convenience.

Student Identification Information

Student Name *

Campus Student ID *

Student Email Address *

Internship Course Information

Course Department, Title, Number *

Example: HD 495 (01)

Instructor Name *

Instructor Email Address *

Site Information

Name of Organization *

Name of Supervisor/Your Contact at Site *

this is the organization representative who has approved your internship opportunity

Email of Supervisor/Your Contact at Site *

Please be sure this information is accurate. An email with the application will be sent to the contact you have identified.

Expected Start Date *

Month

Day

Year

Expected End Date *

Month

Day

Year

Expected number of hours *

Are you being paid (W2 employee making minimum wage or greater) for this opportunity? *

Yes