INTERNSHIP PROPOSAL
Submit this completed form to Steve Pugmire - Steven.Pugmire@uvu.edu
Student Information:
Name: Click here to enter text.
UV ID: Click here to enter text.
Phone Number: Click here to enter text.
Email: Click here to enter text.
Major: Click here to enter text.
Date of Application: Click here to enter text.
Semester: Click here to enter text. Year: Click here to enter text.
______________________________________________________________________________
Internship Description:
1. Position Title and Company: Click here to enter text.
Start date: Click here to enter text.
End date: Click here to enter text.
Hours of work per week: Click here to enter text.
How many hours will it take you to complete your internship objectives/proposed
project? Click here to enter text. (Note: “All semester” is not a sufficient/appropriate answer.
Instead, how many hours?)
Desired Credits? Click here to enter text. (For every 60 hours worked you will receive 1
credit hour — Note: UVU allows a maximum of 9 internship credits earned. However, the
maximum allowed credits hours applied toward a student’s major is dependent on each
department and their academic requirements)
Desired Course (i.e., [course initials] 281R/481R)? Click here to enter text.
Rate of pay: Click here to enter text. Nonpaid: ☐Click here to enter text.
2. Internship Description (Not just your job title, but what are your duties and responsibilities
at your workplace. You may attach a copy of your HR description or the job announcement
to satisfy this section):
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3. Measurable Outcomes: Please develop/define goals regarding your proposed internship that
include measureable outcomes to demonstrate success.
For example: To demonstrate my competencies in leading large scale projects I will:
1. Develop and follow a timeline with milestones
2. Attend four planning meetings with my supervisor
3. Complete 25% of the final deliverable (large scale project) before the semester ends
Click here to enter text.
4. Job vs. Internship: What will you learn that you do not already know?
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5. Description of your Personal and Educational Goals (How will this internship expand
your knowledge and help you in meeting the goals you have for your education?):
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______________________________________________________________________________
Internship Site Supervisor Information:
1. Site Supervisor Name: Click here to enter text.
Title: Click here to enter text.
Company/Organization: Click here to enter text.
Office Phone Number: Click here to enter text. Ext: Click here to enter text.
Email: Click here to enter text. Fax: Click here to enter text.
Address: Click here to enter text.
2. Company Description (Provide a brief description of what it is that your company does. If
you have a link to the company web page, or a brochure, please attach as well):
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______________________________________________________________________________
-For Office Use OnlyFaculty Supervisor & Course Information:
Faculty Supervisor Name: Click here to enter text.
Email: Click here to enter text.
Internship Course Number: Click here to enter text.
Number of Credits: Click here to enter text.