Internship Intake Form | Dr. Boulton
If Dr. Boulton is your internship Supervisor, you will need to follow these steps: http://cboulton.weebly.com/interns.html The Internship Intake Form below is step number 6 and must be completed within the first two weeks of your internship.
Year + Semester
List the year then semester of when your internship will take place (ie: 2017 Spring).
Your answer
Name
Your answer
Student I.D.#
The 7-digit number on your Spartan ID card
Your answer
Major
Your answer
GPA
Your Cumulative Grade Point Average at UT
Your answer
Academic Credit Hours Completed
Number of overall credit hours you have completed to date toward your degree
Your answer
What year are you?
Phone Number
Include area code
Your answer
Email Address
Your answer
Credits
How many academic credit hours is this internship (between 1-4)?
Your answer
Work Hours (per week)
The number of hours you will be working at your internship every week
Your answer
If your internship is paid, what is the hourly rate?
Your answer
Host Site
Where you are interning
Your answer
Host Site Address
Your answer
Host Site Supervisor
Your answer
Host Site Supervisor's Email
Your answer
Host Site Supervisor's Phone
Your answer
Your Learning Objectives
In order for you to earn college credit, everyone (including you, your host site manager, and your faculty supervisor) all need to be on the same page about the educational aspects of your internship. After discussing the internship with your host site supervisor, work together to generate a list of 3-5 specific and reasonable learning objectives: knowledge and skills that you do not currently have but expect the internship experience will teach you. List them here so I can make sure this forms the basis of your supervisor's evaluation of your performance at the end of the internship.
Your answer
UT Supervisor
The last name of the UT faculty member supervising your internship
Your answer
Host Site Evaluation Methods
Also be sure to discuss with your host site supervisor what sorts of feedback and evaluation you will be receiving during the course of your internship. A good baseline would be to establish at least three check-ins: one after the first week, another at the midpoint, and then a final/exit interview at the end. Whatever you and your supervisor agree to, note it here:
Your answer
Agreement
I understand that it is my responsibility to follow the steps outlined here: http://cboulton.weebly.com/interns.html (which include specific instructions for how to write and file a Mid-Term and Final Report) and that not doing so could result in failure of the internship for credit.
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