DESIGN 5191 Course Enrollment Permission Form

Indicates required field

Student Information

Name

First Last

name.#@buckeyemail.osu.edu

Student ID

9-10 digits on BuckID

Design Program Level

Enrollment Term

Form must be submitted before the first Friday of intended enrollment term.

Term

Year (four digit)

Internship Information

We will need the following information to determine if this internship is eligible for credit.

Name of Organization

Address

Address 2

City/Town

State/Province

ZIP/Postal Code

Country

Employer Website

Site Supervisor Name

Site Supervisor Title

Supervisor Email

Position Title

Is this opportunity paid?

Yes

Start Date

End Date

Approximate Number of Hours/Week

Internship Description

Please describe your key responsibilities/job description, expectations discussed with your supervisor, skills you hope to gain, and explain how this internship will further your career goals.