ࡱ> 594] ,bjbjjj .&)b)b %8Nj4@"Y[[[[[[$XYY E0jjj` jB : Individual Internship Application and Grade Assignment Form History Department (Attach additional information if necessary.) Application Date: ______________________ Student Name:___________________________________________________________ Phone Number:_________________________________________ Fax Number:___________________________________________ Email Address:_________________________________________ Prerequisite: INFS ___ 115 ___ 315 ___ 316 Verification: ___ Yes ___ No Internship Name: ________________________________________________________ Internship Site Information: Institution Name:______________________________________________________ Onsite Supervisor Name: _______________________________________________ Onsite Supervisor Address:______________________________________________ Phone Number:_________________________________________ Fax Number:___________________________________________ Email Address:_________________________________________ Qualification: Degree: ___ Ph.D. ___ M.A. ___ Other Discipline: ___ History ___ Other (Specify: ______________ ) Internship Duration: From _______________ to _________________ Work Schedule: Projected Work Hours: Theoretical Learning Information: Research Topic:_______________________________________________________ Describe what you plan to learn about historical research. Possible Primary Sources Identified: Onsite Supervisors Letter Confirming the Availability of the Above to the Student: ___ Yes ___ No Practical Learning Information: Describe practical knowledge you plan to obtain from this internship. ------------------------------------------------------------Office Use-------------------------------------------------------- History Internship Liaison Sponsor: __________________________________________ Completed Academic Internship Agreement Form: ___ Yes ___ No Application Approved: Date ________ Signature _________________________ History Chair: ___________________________________________________________ Application Approved: Date ________ Signature _________________________ Grade Assigned: Onsite Supervisor Report by the 14th week: ___ Yes ___ No 120 Hours Verified: ___ Yes ___ No Acceptable: ___ Yes ___ No Research Paper by the 14th Week: ___ Yes ___ No Acceptable: ___ Yes ___ No Grade: ___ S ___ NS Date _____ Signature _________________________________ 3/08     PAGE  PAGE 3 !6NOWm|}~   ! $ \ ]   1 @ A %GLS`cd¾§§››››››ԛԶhnHo(tHhvVhMhaZrhaZr>* haZrhaZrhXhX5hXhhL haZrhaZrh_c'5nHo(tHh_c'nHo(tHh_c'haZr5nHo(tHh_c'5nHo(tHhaZrhaZr58<O}~7 z   =  _  hgdaZr hgdL gdL $a$gdaZr   B C %&defghijklmgd_c' hgdaZrdijlPVnopqsvwJLVxuvwﵨŤwh_c'h5hhO+h~H*h7$ah~5h~nHo(tHh~hX5h~h_c'CJaJnHo(tHh_c'h_c'CJaJnHo(tHh_c'nHo(tHhXnHo(tHhO+hL haZrhL hM5hMhvVhvVnHo(tHhX,nopqrstuvwGJ&) hgdL  hgdaZr)vw$'_` hgd~$*8BD    $%&'()*+,ÿh J0JmHnHuhLu hvV0JjhvV0JUh3vjh3vUhvVhvVCJaJhvVCJaJhvVhXh hhhhH*hh5h~hh_c'h5h_c'h_c'5nHo(tH,    hgd~()*+, hgd~ &`#$gdLu ,1h/ =!"#$% s2&6FVfv2(&6FVfv&6FVfv&6FVfv&6FVfv&6FVfv&6FVfv8XV~ 0@ 0@ 0@ 0@ 0@ 0@ 0@ 0@ 0@ 0@ 0@ 0@ 0@ 0@PJ_HmH nH sH tH @`@ NormalCJ_HaJmH sH tH DA`D Default Paragraph FontRiR  Table Normal4 l4a (k (No List 4 @4 vVFooter  !.)@. vV Page NumberPK![Content_Types].xmlN0EH-J@%ǎǢ|ș$زULTB l,3;rØJB+$G]7O٭Vc:E3v@P~Ds |w< , & $$$'d,  ),   '!!8@0(  B S  ?        ' * - EG*,pr>AlqN Z       * - 333333333333333333nrswLw         * - - L _c'O+B? JX7$aaZr2t3v~LuYMvV\  @, @UnknownG*Ax Times New Roman5Symbol3. *Cx ArialG=  jMS Mincho-3 fgA$BCambria Math"1hf'f'Fa a !4  2QHP)?aZr2!xx &Individual Internship Application Formkramer01 Wendy HelmOh+'0 0< \ h t (Individual Internship Application Form kramer01 Normal.dotm Wendy Helm2Microsoft Office Word@@ܲN@ʶ @ʶ a ՜.+,D՜.+,p, hp   ϳԹ  'Individual Internship Application Form Titlel P0<HT` Priority4display_urn:schemas-microsoft-com:office:office#WhoWho Remediated?CommentAttached on new site?Dept 2-MediumLaura Kokkila17610  !"#%&'()*+-./0123678;<R>?@ABCDEFGHIJKLMNOPQSRoot Entry F[ :@ 1TablejWordDocument.&SummaryInformation($DocumentSummaryInformation8,MsoDataStore   3GZ3UOAQ==2 P Item PropertiesSXCPBA3UIHXF4==2  ` Item  Properties OYMGERDKX0IQXZZA==2   Item =(Properties@CompObj#r  !"$ DocumentLibraryFormDocumentLibraryFormDocumentLibraryForm This value indicates the number of saves or revisions. The application is responsible for updating this value after each revision. metaAttributes"/>  F Microsoft Word 97-2003 Document MSWordDocWord.Document.89q