Undergraduate Internship Form

This form is to be used to request approval for Undergraduate Internship Credit (THEA 4541) and should be completed prior to beginning your internship.  After you complete this form it will be routed to your advisor for approval and signature before becoming part of your permanent academic record.

Name*
Must be your @memphis.edu email
U00....

We will now ask about your supervisor for your internship.  This is the person who will ultimately report to us about your work.  It is typically either the head of the internship organization or the person who will oversee your work most directly.  We will need enough information to be able to contact them in some fashion so be sure to provide as much information as you are able in this section.

If known
If known
As much as you are able, we will attempt to determine who is supervising you
What will you be doing?
Use your mouse or finger to draw your signature above
Date*

Advisor Review

Advisor Name
Do you approve of this internship?*
Will NOT appear on internship form
Use your mouse or finger to draw your signature above
Date