Internship Acceptance Form
Please complete this form AFTER you have confirmed that you have been accepted at your internship site.
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First Name *
Last Name *
PSU Access ID (first part of email address) *
(i.e. abc123)
Academic Level *
How did you find your internship? *
check all that apply
Major *
Email address
(if providing PSU address, please type out )
Mailing Address
Cell Phone Number
Completing Internship: *
Semester(s) registered for internship *
Year(s) registered for internship *
Anticipated Graduation Semester *
Anticipated Graduation Year *
Your title/function at internship *
(i.e. Marketing Intern, Sales, Human Resources, Case Manager, etc.)
Organization Name *
Organization Department
Work Site City *
Work Site State *
Supervisor Name *
Supervisor Title
Supervisor Phone
Supervisor email
Type of Organization
Clear selection
Type of Internship
Internship Course *
Number of credits being earned
(i.e. HDFS = 9)
Are you being paid / compensated for your internship? *
Amount paid
(enter 0 if unpaid - please enter numbers only without $, per hour, etc.)
amount indicated is:
Clear selection
Internship Coordinator *
Method of internship
Clear form
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