Internship Proposal - Cal Poly Journalism

Internship Proposal Form

To be completed by internship provider in consultation with student intern.
Date:*
Academic Quarter Proposed:*

Fall (Sept-Dec)Winter (Jan-March)Spring (April-June)Summer (June-Aug)
Student Name:*
Student Email:*
Student Phone Number*

Area CodePhone Number
Internship Provider:*
Company Website
https://
Supervisor Name:*
Supervisor Title: *In the event that the internship supervisor has not supervised an internship previously, the Journalism Department may request information about the supervisor’s credentials in order to satisfy the component related to the granting of academic credit.
Supervisor Email:*
example@example.com
Supervisor Phone:*

Area CodePhone Number
Company Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Start Date*
End Date*
Proposed Work Schedule (hrs/wk) (# of wks)*
Compensation*
If so, what is the rate of pay?
Will the student have any face-to-face interaction? (Cal Poly requires additional paperwork for in-person internships.)*

YesNo
Description of Proposed Duties [What will the student be doing during the internship?]*
Description of Learning Objectives [These should be written as: "The intern will learn how to... . " Objectives must be tied to educational goals in news or public relations, which are the two tracks in the journalism program. These objectives should go beyond simply learning to be responsible and complete assignments. To receive credit for the internship course, the student is required to submit a portfolio of work demonstrating mastery of these Learning Objectives. Typically, employers will provide 3-5 Learning Objectives for their interns.]*
Description of Teaching Methods [How will the internship provider/employer ensure that the student is learning new skills or methods related to the student’s concentration?]*
Evaluation Criteria [How will the internship provider measure the student’s success in learning during the internship so that a faculty member can legitimately assign credit and/or a grade to the internship?]*
Student Emergency Contact Info

To be filled out with student
Contact Name*

First NameLast Name
Relationship to Student*
Contact Phone Number*

Area CodePhone Number
Contact Email*
example@example.com
Verification
Electronic Signature of Internship Provider:*
Should be Empty:

Internship Proposal Form

Student Emergency Contact Info

Verification