Internship Petition Directions
Use the information below to assist you as you fill out the Internship Petition. If you have any questions, contact the CES
Coordinator for assistance. The Internship Petition document is a Word file which has been set up as a form. After
clicking on the link, the document will open in Microsoft Word. You should save the file to your computer or disk. All
information needs to be typed on this form. Once completed, print the form for signature. Petitions with handwritten
information in Parts A, B & C will be denied.
Part A: Student Information
This section includes all pertinent information about you. Here are some important tips about the various information
requested.
International Student Visa
It is important that we know if you are attending Ithaca College on an International Student Visa. Check 'Yes' if you are or
'No' if you are not. Being on a Student Visa does not preclude you from completing an Internship, however, the Office of
International Program needs to be notified and you will need to complete some additional paperwork with their office. All
International students must contact the Office of International Programs (274-3306) early in the application process.
E-mail
Provide us with the e-mail address that you will check regularly from now until the date you finish the internship
assignment. We prefer that you use your Ithaca College e-mail address, however if you do not check this account
regularly, please provide an alternative e-mail address.
Local Address & Phone
This is where we can contact you while you are taking classes in Ithaca. Be sure to include Street, City, State, Zip, and
Area Code!
Permanent Address & Phone
This is an address where we can reach you while classes are not in session in Ithaca. If you have a cell phone, please
include that number in this section as well (include the words 'Cell Phone#' prior to the actual number so that we know
what number it is) . Be sure to include Street, City, State, Zip, and Area Code.
Major, Specialty/Minor
You need to include your major (e.g. Clinical Exercise Science, Exercise Science, etc.) . If you have declared a Specialty
or a Minor, include this information also. If you have not yet declared a Specialty/Minor, leave this section blank.
Part B: Facility/Site Information
To fill in this section, you will need to obtain specific information about the that you will be completing your internship
at. Here are some important tips about the various information requested.
Name/Address of Facility
When filling out the address, it is important that you include the address where you are actually going to be. Some
facilities have branch offices. If this is the case, you need to include the address of the branch office where your
supervisor is located rather than the main address. If you are not sure which address to include, include both! Be sure to
include Street, City, State, Zip in the address box.
Site Supervisor/Title/Phone/E-mail
If you select a site from the approved list, you should fill in the name provided. For new sites, type you will need to work
with your Faculty Sponsor to obtain the name of the person at the site who will be directly responsible for your day to day
activities during the fieldwork. You must include all of this information on the petition form before you can be registered
in the course. When you hand in this form to your Faculty Sponsor, he/she will contact this person to discuss the
placement.
Start Date/Completion Date
Be specific here. Do not simply put the month and year... you must have a day indicated for both start and end (e.g.
month, day and year) dates. The specific dates should be something that you have discussed with your IC Faculty
Sponsor. Also, when discussing dates, it is important to remember that you cannot schedule yourself for more than40
hours in any week. Also, please note that most sites do not follow the Ithaca College "academic calendar" of
vacation/breaks/holidays. It is your responsibility to check with your site supervisor about calendar related events prior to
the start of your fieldwork.
Part C: Course Information
In this section, you need to include information about the specific internship course that you will be enrolled in. You must
fill in information about each of these areas. If information is not provided, the petition will be denied.
Course
Before checking one of these boxes, be sure to check to make sure that you meet the prerequisites. Only check one box...
checking multiple boxes or failure to check a box will result in the petition being denied. If you have checked EXSS46000 (Internship in Exercise & Sport Sciences), remember that you will need to attach a course outline with the petition.
Your Faculty Sponsor will help you create this document.
Number of Credits
Internships can be taken for 6-12 credits. The more credits you register for, the more time you will need to spend at the
facility. For example, if you choose to enroll for a 6-credit Internship, you will be on site for 300-360 hours, whereas if
you enroll for a 12-credit Internship, you will be on site for 600-720 hours. The number of credits should be discussed
with the CES Coordinator and your Faculty Sponsor prior to filling out this petition.
Semester of Registration
Indicate which session (Fall, Spring, Summer I or Summer II) you want to enroll in this course. Your Faculty Sponsor will
help you with the selection of the appropriate registration session. Choose only ONE box. The petition will be denied if
multiple boxes are checked.
IC Faculty Sponsor
Type in this box the name of the Ithaca College Faculty member who will be working directly with you. In some cases,
this may be the CES Coordinator, however, in some cases it may be a different faculty member. .