"Internship Enrollment Form - the College of New Jersey"

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The College of New Jersey
Office of Records & Registration
P.O. Box 7718, Ewing, NJ 08628-0718
609-771-2141
INTERNSHIP ENROLLMENT FORM
ID #:
NAME:
___ ___ ___ ___ ___ ___
Last
First
M.I.
(6 digit PAWS ID)
PHONE:
EMAIL:
MAJOR:
SEMESTER: Fall ____ Spring ____ Summer ____ Year: _________
Student’s Cumulative GPA: _________ (Must be 2.5 or greater) Student’s Status __________ (Must be Junior or Senior)
COURSE ID: __________________ SECTION ID: ______________ (for Records & Registration only)
INSTRUCTOR: ______________________
GRADING: Normal Letter Grades: _____ or Pass/Unsatisfactory _____
INTERNSHIP UNITS*: _________ (Not to exceed 1.5 course units except in certain approved programs such as Health &
Exercise Science)
Total number of registered units for this semester, including internship: ________ (May not exceed 4.5 Units)
Total number of internship units student will have completed at the end of this semester: ________ (May not exceed 3.0
Units)
Completed proposal to be submitted to: ____________________________ on _________________ (mo/day/yr)
Academic Department
Full proposal documenting course of study must be filed with the Instructor.
INTERNSHIP ORGANIZATION (Also indicate on Proposal): __________________________________________
ADDRESS ____________________________________________________________________________________
Street
City
State
Zip
SUPERVISOR: ________________________________________________________________________________
Title
Phone
Email
START-END DATES OF INTERNSHIP:
TYPE OF INTERNSHIP (Check one of the following):
Credit only or
Credit & Stipend/Salary Hourly Rate
/hr. HOURS PER WEEK
Please sign and date where indicated. All signatures must be completed before registration will be processed.
STUDENT: __________________________________________________
DATE: ______________________
*By signing this form, I acknowledge that I am responsible for the payment of all tuition and fees associated with the number of units
earned from this course.
SUPERVISING FACULTY: ____________________________________
DATE: ______________________
DEPARTMENT CHAIR (or Designee): ___________________________
DATE: ______________________
DEAN (or Designee): _________________________________________
DATE: ______________________
This Internship Enrollment Form must be submitted to the Office of Records & Registration at the time of registration. Registration will
not be permitted if this form is incomplete and/or there are missing signatures.
Original: Records and Registration Copies: Career Services
Revised 10/2014
The College of New Jersey
Office of Records & Registration
P.O. Box 7718, Ewing, NJ 08628-0718
609-771-2141
INTERNSHIP ENROLLMENT FORM
ID #:
NAME:
___ ___ ___ ___ ___ ___
Last
First
M.I.
(6 digit PAWS ID)
PHONE:
EMAIL:
MAJOR:
SEMESTER: Fall ____ Spring ____ Summer ____ Year: _________
Student’s Cumulative GPA: _________ (Must be 2.5 or greater) Student’s Status __________ (Must be Junior or Senior)
COURSE ID: __________________ SECTION ID: ______________ (for Records & Registration only)
INSTRUCTOR: ______________________
GRADING: Normal Letter Grades: _____ or Pass/Unsatisfactory _____
INTERNSHIP UNITS*: _________ (Not to exceed 1.5 course units except in certain approved programs such as Health &
Exercise Science)
Total number of registered units for this semester, including internship: ________ (May not exceed 4.5 Units)
Total number of internship units student will have completed at the end of this semester: ________ (May not exceed 3.0
Units)
Completed proposal to be submitted to: ____________________________ on _________________ (mo/day/yr)
Academic Department
Full proposal documenting course of study must be filed with the Instructor.
INTERNSHIP ORGANIZATION (Also indicate on Proposal): __________________________________________
ADDRESS ____________________________________________________________________________________
Street
City
State
Zip
SUPERVISOR: ________________________________________________________________________________
Title
Phone
Email
START-END DATES OF INTERNSHIP:
TYPE OF INTERNSHIP (Check one of the following):
Credit only or
Credit & Stipend/Salary Hourly Rate
/hr. HOURS PER WEEK
Please sign and date where indicated. All signatures must be completed before registration will be processed.
STUDENT: __________________________________________________
DATE: ______________________
*By signing this form, I acknowledge that I am responsible for the payment of all tuition and fees associated with the number of units
earned from this course.
SUPERVISING FACULTY: ____________________________________
DATE: ______________________
DEPARTMENT CHAIR (or Designee): ___________________________
DATE: ______________________
DEAN (or Designee): _________________________________________
DATE: ______________________
This Internship Enrollment Form must be submitted to the Office of Records & Registration at the time of registration. Registration will
not be permitted if this form is incomplete and/or there are missing signatures.
Original: Records and Registration Copies: Career Services
Revised 10/2014