Honors Internship Application
Directions:
- Before filling out this form, fully read the Honors Internship Directions and the Honors Internship Completion Report.
- On the application, please type the requested information into this Word Document, save a copy for your own records, print the document, and then gain the required signatures.
- All requested materials must be submitted to the Honors College at least one week prior to the deadline for registering for a full-semester course for the term in which the internship will be completed. Students are strongly advised to work with Dr. Bradley at least one month in advance prior to the date you wish to enroll the Honors Internship course.
- Do not save this document as a PDF. Please submit it as a Word document.
Student Name:
WKU ID #:
WKU Email:
Local Address:
Student’s Major:
Will you enroll in HON 275 or HON 375?
Which semester will you enroll in this course?
Name of organization or entity sponsoring your internship:
Name and title of primary supervisor for internship:
Internship supervisor’s primary email and phone #:
Beginning and end dates for internship:
In the space below, please list the name, department, WKU email, and WKU phone # of two faculty members who can speak to your academic maturity and readiness for an Honors internship course.
In the space below, please explain in 100-200 words why you wish to complete an internship and what you hope to gain from this experience.
Important: Along with this Honors Internship Application, please submit on official letterhead of the sponsoring organization or entity a signed statement from your internship supervisor stating: 1) confirmation that you have been accepted to participate in this internship, and 2) all duties associated with the internship, the amount of hours total you will serve in the internship, the amount of hours per week you will serve for the internship, the start and completion dates of the internship, names and contact information of relevant supervisors, and compensation (if any) for duties performed. Your application will not be evaluated or approved without this document.
At the conclusion of the internship period, the internship supervisor must contact the Honors Internship course instructor to verify in writing that the student has completed all of the agreed upon duties associated with the internship to the supervisor’s satisfaction. This confirmation can be emailed to Dr. Bradley at from the supervisor’s professional email account.
Signatures
Student Signature
The information I have supplied is correct to my knowledge. I will represent Western Kentucky University and the Honors College to the utmost best of my abilities during this internship experience and submit all required material as part of my course grade. Failure to submit this material by the stated deadline will result in my failure of the course.
Signature:
Printed Name:
Date:
Honors College Director Approval
I support and approve the Honors Internship proposed by the above student and will serve as the faculty member of record. As faculty member of record, I will advise the student on the required course material, evaluate this material at the conclusion of the internship, and submit the earned grade to the Registrar’s Office.
Signature:
Printed Name:
Date: