Arizona Legislative and Government Internship Program Course Credit Form

This form is due to the School of Politics and Global Studies reception desk on the 6th floor of Coor Hall or via email in
PDF format to by 4 p.m. on December 13th, 2016. It must be submitted before you sign up for internship course credit for Spring 2017. Your name will not be confirmed to your agency until this form is on file.

Student Name (print) ______Student ASU ID# ______

Student ASU Email Address ______

You are required to have this form signed by an academic advisor from each school or department from which you wish to receive internship course credits. You must also report the name and ASU email address of each faculty member responsible for submitting the grade for your internship course credits.

Undergraduate students will receive 12 internship course credits and graduate students will receive 9 internship course credits (i.e. courses ending in 84 such as POS 484 or 584) through this program.

It is up to the school or department issuing the internship course credits to determine if the credits will be pass/fail or letter graded. Some, such as those under the College of Liberal Arts and Sciences, do not allow pass/fail credits to count toward major, minor, or certificate program requirements.

You must report any additional course credits you plan to take in Spring 2017 and receive permission from your government agency internship supervisor to do so.

Additional Course _____ Additional Course _____

# of Additional Credits ____ # of Additional Credits_____

Complete a section for each school and/or department from which you plan to receive internship course credit.

School or Department 1 ___________
______
Intern Course _____ Intern Course*_____
*Applicable if more than one internship course is taken in the same school or department.
# of Intern Credits____ # of Intern Credits____
Academic Advisor Name (print)
______
Academic Advisor Signature Date
______
Faculty Member Submitting Your Grade Name (print)
______
Faculty Member Submitting Your Grade ASU Email
______
Student Signature Date
______ / School or Department 1 ___________
______
Intern Course _____**
**Applicable if internship courses are taken in more than one school or department.
# of Intern Credits____ # of Intern Credits____
Academic Advisor Name (print)
______
Academic Advisor Signature Date
______
Faculty Member Submitting Your Grade Name (print)
______
Faculty Member Submitting Your Grade ASU Email
______
Student Signature Date
______

Contact Financial Aid and Scholarship Services (https://students.asu.edu/contact/financialaid) if you have any scholarships or financial aid that may be affected by this course agreement. It is your responsibility to know the implications of the internship for your individual circumstance.

Questions about this form? Contact Dr. Tara Lennon at .