Department of English at Ball State University
INTERNSHIP APPLICATION & SITE SUPERVISOR AGREEMENT
Name:
Date:
Address:
Phone:
Email:
Student ID#:
Internship Semester:
 Fall
 Spring
 Summer
Major:
Status:
Minor:
 Sophomore
 Junior
 Senior
 Graduate Student
About your internship:
Name of business/organization:
Address:
Site Supervisor:
Supervisor’s Title:
Supervisor’s Email:
Supervisor’s Phone:
Hours per week:
Pay per hour (if applicable):
 7.5 (3 credits)
 15 (6 credits)
 22.5 (9 credits)
 30 (12 credits)
Assigned tasks & responsibilities:
For site supervisor:
As a representative of the above business/organization, I acknowledge that the above information, job
description, internship period, and pay (if appropriate) are accurately stated. As the site supervisor, I
agree to train, supervise, and evaluate the student intern in the performance of the above tasks, duties,
and responsibilities. I understand I will be asked to complete a midterm and final evaluation of the
student which will be used in determining the grade the student receives for his/her internship hours.
_________________________________________
Site Supervisor Signature
_________________________________________
Student Signature
__________________
Date
__________________
Date
This form must be completed, signed, and returned to the English Department Internship
Coordinator (RB 297, FAX 765-285-3765, or engintern@bsu.edu) before you can register
for your internship credits.