CIS INTERNSHIP
Course Entry Proposal
Contact Information
Name:
[FirstName, LastName]
Email Address:
[email address]
Phone Number:
[phone number]
Mailing Address:
[mailing address]
[mailing address]
Experience in the CIS program
[Note to applicant: describe what you have learned, experiences you have
enjoyed. Delete this note.]
Learning Goals
Career/Life Goals
Target Company Description
Job Description
This proposal has been discussed with and approved by the on site mentor,
faculty mentor, and department chair.
______________________________________ ______________________________________
Student’s Signature
Date
Faculty Coordinator’s Signature
Date
______________________________________ ______________________________________
Mentor’s Signature
Date
Department Chair’s Signature
Date
[Note to applicant: This page should be signed at the time you submit this
proposal for entry into ITEC 4396 by you, the student, and your on-site mentor
only. This proposal must be submitted to your faculty coordinator, and program
manager. You must turn this is as a hard copy. NO electronic submissions.
Delete this note.]