193 Internship Application Form

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Department of Geography
Internship in Geography: Geography 193
Academic Year 2017 – 2018

Internship Application

Please review the internship requirements listed in the course syllabus. Return this completed form with signatures from your internship supervisor (or faculty supervisor) to Patty Murray after you have Dr. Vena Chu sign it. Patty will then give you the approval code so you can add this class, by the Add/Drop deadline for the quarter you wish to enroll in 193.

To be completed by the student:                  Quarter: ____________________________


Phone: _______________________________

Local Address:_____________________________________________________________

Perm Number: _____________________________    G.P.A. _________
Faculty Sponsor: (same as Faculty Supervisor if Internship in UCSB Geography Department)


Geog. 193 Units: ___________________________

To be completed by Student or Agency Supervisor:

Agency Supervisor: (or Faculty Supervisor)  _________________________________________________________________

Phone Number:  _____________________________

Agency Name:__________________________________________________________

Agency Address:________________________________________________________


By Add/Drop: Resume _______    G.P.A._______                G.P.A. Waiver _______
Internship Application _______      Interim Report _______     Student Final Report _______