/ / Internship Course Application

Students interested in BME 484 or BME 584Internship credit must be hired for an eligible internship and meet the criteria for the internship course. See the BME Internship Guidelines for student and position eligibility requirements and application materials.

PLEASE PROVIDE THE FOLLOWING INFORMATION:

1. Student information

Last Name / First Name / 10 Digit Student ID #
Phone / ASU E-mail Address / Major
Overall Cumulative GPA / Total # Credits Completed / Semester/Year Course To Be Taken

2. Employer information

Company Name / Supervisor Name / Supervisor Email
Internship Start/End Dates
- / Hours Per Week / Is this internship paid or unpaid?

3. Course information

BME 484, Undergraduate Internship

BME 584, Graduate Internship

Number of projected work hours during term:

Note: 45 hours of work time required for each academic credit earned.

Number of credit hours to be earned:

4. Description of the work to be completed during the internship:

5. Description of the applicability of the internship to the academic program:

6. Description of how the position will provide learning beyond the classroom:

7: Student Acknowledgement

A completed Student Placement Agreement is on file with the Engineering Career Center. For more information, visit:

I have attached:

Copy of position posting

Letter from employer verifying my hire and agreeing to the commitment of supervising tasks and provision of feedback

Upon completion of the internship, an End-of-term report will be submitted to the appropriate Chair (see below). The End-of-term report includes a mid-term evaluation. See the BME Internship Guidelines for additional details regarding the requirements for this report.

Undergraduate Program Chair: Dr. Jeffrey Kleim ()

Graduate Program Chair: Dr. Christopher Buneo ()

STUDENT SIGNATURE

Date

APPROVAL SIGNATURE

Graduate or Undergraduate Program Chair / Date

Note: Once approved, astudent will be issued an override in order to complete registration and an email confirmation will be sent by the SBHSE Academic Advising Center.