Practical Experience Approval Form
Prior to submitting this form, please discuss this practical experience with your Concentration Adviser
Choose the name of your concentration
*
Please Select
Archives
Book Studies
Collaborative Innovation
Community Engagement & Social Change
Environmental
Global Finance
Interdisciplinary Making
Journalism
Museums
Poetry
Translation Studies
Student Name
*
First Name
Last Name
Student Email Address
*
example@smith.edu
Planned Graduation Year
*
Form Submission Date
*
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Month
-
Day
Year
Date is auto-filled
Concentration Adviser Name
*
First Name
Last Name
Concentration Adviser Email
*
Form will be sent to your adviser for approval, please ensure correct spelling
Details of the internship, volunteer, or work experience
Name of Organization
*
Type in the name of the organization or business where you will complete your practical experience
Organization Website
Location
Type in the city and state (or country); please specify if remote
Internship Supervisor Name
First Name
Last Name
Supervisor Phone Number
Supervisor Email
Describe the proposed internship, volunteer, or work experience, including the type of work you will do and the kind of supervision you will receive.
*
How will this practical experience support your work in the concentration?
How will your work support the partner organization or their community?
Start Date
*
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Month
-
Day
Year
Date
End Date
*
-
Month
-
Day
Year
Date
Anticipated total work hours
*
Submit
Should be Empty: