College of Earth, Ocean, and Atmospheric Sciences
Oregon State University
104 CEOAS Administration Building
Corvallis, OR 97331-5503
Internship Approval Form
ENSC 410 / GEO 410
You must complete this form PRIOR to reigstering for internship credits (ENSC 410 or GEO 410):
1. Complete all information in the form and sign it (electronic signature in Adobe or Acrobat preferred);
2. Forward it to your Internship Supervisor for their signature;
3. Submit the completed form directly to Jessica Cardinal-Lanier, the Experiential Learning Coordinator
 Note: OSU cannot authorize internships in Maryland, Massachusetts, New Hampshire, and Tennessee.
Student Information
Last Name:
First Name:
OSU ID:
Internship & Supervisor Information
Internship Position Title:
Internship Host Organization:
Name and Title of Supervisor:
Supervisor Email:
Phone Number:
Address:
City:
State:
Zip:
Country (if outside USA):
Internship Details
Course (select one): ENSC 410
Term(s):
Internship Start Date:
Internship End Date:
Hours per week:
Estimated Total hours:
Year:
# of credits (1-12)*:
*1 CR = 30 hours of work
Paid or Volunteer?
Describe your internship and be specific as possible. What type of work will you be performing? What are the
objectives of the project(s)? Who are you working for and what is the mission of the organization?
Briefly describe your academic interests and professional goals. What career path do you envision for yourself in the
first few years after graduation? How will this internship help you along that path?
Identify at least three learning objectives. What specific skills relevant to your degree program and professional goals do
you hope to acquire by completing this internship?
What process or methods will you employ on a regular basis to critically evaluate whether you are meeting your learning
objectives during the course of your internship? This could include daily to weekly meetings with your supervisor, coworkers, and other interns, and/or critical reflection captured in a regular work log.
Required Signatures*
Student Signature:
Date:
Supervisor Signature:
Date:
Submit this completed form via email to Jessica Cardinal-Lanier, CEOAS Experiential Learning Coordinator. Once the internship is
approved, a course override will be completed and the student will be able to register for ENSC/GEO 410.
* If you have trouble with electronic signatures, a scanned copy submitted via email or a hard copy are acceptable.
Mail: 104 CEOAS Administration Building, Oregon State University, Corvallis, OR, 97331-5503
Drop off: 104 Wilkinson Hall, OSU
Fax: 541-737-1200
CEOAS Approval:
Date: