Iowa State University Internship Program Form This form is used to authorize an internship or cooperative education program. The form must be completed and approved prior to offering any internship and is in effect unless there is a significant change in the program (e.g., in scope or risk level) that would require that a new form be initiated. Name of Internship/Co-op Program Check if Program is a Research Experience for Undergraduates (REU) Department College/Division Contact Name ________________________________ Contact Phone ______________ Contact Email _______________________ Intern Supervisor (If different from Contact Name _______ Will academic credit be offered? Yes No Paid Internship? If yes, amount to be paid ________________________ Funding source _ ___________________________________ Unpaid Internship? Internship Start Date ______Internship End Date _______ And/or Duration of Internship: Fall Spring Summer Other Estimated number of Internships offered ______________________________________ Estimated Internship schedule or hours/week _________________________ Participants of the Program are: ISU students U.S. High School Students Non-ISU domestic students Non-ISU international students Other: ____________ Will participants be age 18 or older? Yes No (If NO, or if ANY participant will be under the age of 18, in addition go to: for additional ““ requirements) I. Brief Description of Program: II. Learning Objectives for Internship:
Iowa State University Internship Program Form This form is used to authorize an internship or cooperative education program. The form must be completed and approved prior to offering any internship and is in effect unless there is a significant change in the program (e.g., in scope or risk level) that would require that a new form be initiated. Name of Internship/Co-op Program Check if Program is a Research Experience for Undergraduates (REU) Department College/Division Contact Name ________________________________ Contact Phone ______________ Contact Email _______________________ Intern Supervisor (If different from Contact Name _______ Will academic credit be offered? Yes No Paid Internship? If yes, amount to be paid ________________________ Funding source _ ___________________________________ Unpaid Internship? Internship Start Date ______Internship End Date _______ And/or Duration of Internship: Fall Spring Summer Other Estimated number of Internships offered ______________________________________ Estimated Internship schedule or hours/week _________________________ Participants of the Program are: ISU students U.S. High School Students Non-ISU domestic students Non-ISU international students Other: ____________ Will participants be age 18 or older? Yes No (If NO, or if ANY participant will be under the age of 18, in addition go to: ““ for additional requirements) I. Brief Description of Program: II. Learning Objectives for Internship: