IUPUI Department of Sociology

R494 Internship Proposal Form (1/07)

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Student information (to be completed by student):

This internship proposal is presented for ___________    Credits desired in R494: ________ Semester: ______________

Name:_____________________________________________             E-mail: __________________________________

Address: _________________________________________________________________________________________

Phone: _________________  Cell:_____________________Major: __________________  Minor: __________________

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Internship site – to be completed by student and job supervisor, in consultation with the faculty advisor:

Company/Agency name: ______________________________________________________

Address: ___________________________________________________________________

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Hours per week: _____________                                   Salary: _______________

Starting date:        _______________                             Completion date: ___________________

Note any planned days of absence, e.g., IUPUI Thanksgiving/spring break: ______________

How often will the intern and job supervisor meet together to discuss intern progress? ___________________

Attach a description of all work tasks and responsibilities.

Attach a description of at least three learning objectives to be mastered during the internship.  These objectives should be specific.  One should relate directly to the student’s work assignment and should be mastered by “direct” experience.  (Example:  Develop communication skills related to assessing client needs.).  The second learning objective should be learned through observation.  (Example: Develop an understanding of client-staff relations in a social service agency as observed by sitting in on client meetings.)   The third should be learned through the student’s independent study of the organization.  (Example: Learn how a youth-serving organization seeks to reduce social problems through after-school programs.)

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Employer’s (over all supervisor’s) name/title (please print):       _________________________________________________________

Employer’s signature: ____________________________________________________

Telephone: ____________________________        E-mail: _______________________________

(Actual) Job supervisor’s name/title (please print) ___________________________________________________________________

Job supervisor’s signature: _________________________________________________

Telephone: ____________________________        E-mail: ______________________

Faculty advisor’s name (please print): _________________________________________

Faculty advisor’s signature: ________________________________________________

Telephone: ____________________________        E-mail: ______________________

Copies of this proposal should go to the employer, job supervisor, faculty advisor, undergraduate director of sociology, and the student.