Internship Placement Form

Fordham University Internship Placement Form

You must complete this form upon obtaining an internship*

**This Form Is Not For Credit But For Placement

STUDENT INFORMATION

Name

Fordham ID #
-

LOCAL ADDRESS

PERMANENT ADDRESS
Check if same as local

Street or Residence Hall
City
State	Zip
Phone - -

Street
City
State	Zip
Alternate Phone - -

Fordham Email

Major

Campus:
FCRH FCLC FCLS CBA GSAS

Graduation Date

Please also include one EMERGENCY CONTACT:

Name

Phone
- -

ORGANIZATION INFORMATION

Organization	Department
Supervisor	Supervisor's Title
Address:	City
State	Zip
Email	Phone - -
Fax - -

For Students Receiving Internship Credit (NOTE: If your internship is UNPAID, you MUST OBTAIN CREDIT. Speak to your Dean).

Is this an internship for Credit? Yes No

Arrangements have been made for to receive academic credit by enrolling in the with professor/Dean at Fordham University for her/his participation in an internship at the organization named above during the semester.

This internship starts on
Select Date

and ends on
Select Date

WORK SCHEDULE Note: *Interns follow the organization’s holiday schedule, not that of the University (ie. time off for school breaks need to be arranged with the supervisor).
Mon.	Tues.	Wed.	Thurs.	Fri.	Sat.

If you need a credit letter for your employer, ram van passes, or have any additional questions please contact Career Services at (718) 817-4350 or visit www.fordham.edu/career and click on Internships.