Elective Internship and Doctoral Practicum Registration Request Form
Please use this form once you have identified your internship or practicum site and are ready for APUS
approval. Please email your completed registration request form to careerservices@apus.edu.
Upon receipt of this completed request form, APUS will contact the Site Supervisor listed to confirm
your internship. If this experience is for credit, you will not be registered until your internship/practicum
learning agreement form is approved, and all other documents are received by your APUS point of
contact (POC). You are responsible for the timely submission of all required documentation. Failure to
do so may delay or otherwise impede your ability to register and complete your internship. Deadlines
and timelines are outlined on the Internship Checklist Form.
Every student, regardless of whether the proposed internship is for credit, is required to fill out Section
1 of this form. Only those students seeking academic credit through the completion of an internship
course is required to fill out Section 2 of this form.
SECTION 1 (Section must be fully completed for your registration request to be processed)
Note: Email is the primary method of contact for our offices. Therefore, it is important that you verify all email
addresses listed below are correct.
Student Information:
Student Name:
Degree and Program (ex: M.A. Intel. Studies):
Address if different during internship:
Student ID:
Last 4 of SSN:
Email:
Primary Phone:
Today’s Date:
Internship Information:
Organization/Company:
Site Supervisor Name:
Site Supervisor’s Title:
Start Date:
End Date:
Street Address:
City:
Email:
Primary Telephone:
Hours per week at site:
State:
Zip:
Total Onsite Hours (min. 120):
Brief Summary of Experience:
SECTION 2 (Complete ONLY if you are registering for an internship course to gain academic credit)
Internship and Practicum Consent to Register Form/Payment Approval
Course Information:
Course Code:
Session Start Date:
Funding Type:
The following table contains course codes from schools offering internships (not practicums) for credit:
Degree Level
Security & Global Studies
STEM
Business
Associate’s Degree
SSGS495
STEM195
BUSN295
Bachelor’s Degree
SSGS495
STEM495
BUSN495
Master’s Degree
SSGS595
STEM695
BUSN695
Doctoral Degree
DOCT897
not offered
not offered
Upon approval from APUS, and with the receipt of the other required documents by the deadline of 5
business days prior to the course start, APUS will then register you for the course requested on this
form. Completing and submitting this form acknowledges and grants your consent for APUS to proceed
with any approved course registration for you.
Internship/Practicum Termination
A student must participate in an approved internship/practicum experience during this course, and is
required to have a minimum of 120 hours on site to fulfill the academic requirements for 3 semester
hours. If a student’s hours are cut or the student is released from the experience or chooses to stop
attending the experience, the student must immediately notify the faculty member, and may be
required to withdraw from the class. If a withdrawal is required, a refund will be based on the current
schedule set by APUS. If the student does not withdraw, the student may receive a failing grade.
Student Signature: __________________________________________
Date: _______________