Internship Requirement Form

Internship Waiver Form

(For Currently Enrolled EADP majors ONLY)

Please print out, and complete fully and accurately. Return form to Dr. James Kendra, WH 366C

Name: _________________________________

Address: ______________________________ Student ID# ________________________

City, ST: ___________________________ Phone: ___________________________

E-mail: ___________________________

Is EADP your lst or 2^nd major? yes no If not, what is your major? ___________________

Do you have professional work experience? yes no

Is/Was this employment in or related to the field of emergency management? yes no

If so, what percentage of your work day is/was devoted to emergency management issues? _________________________________________________________________________

Job/position title: _____________________________________________________________

Describe your responsibilities and duties performed:

_________________________________________________________________________

How long have you worked/did you work in this field? ________________________________________

Are you currently employed in this profession? yes no

When did you terminate your employment in this field? _________________________________

Provide any other relevant work experience or additional reasons why you believe your internship requirement should be reconsidered:

_________________________________________________________________________

Please attach a current resume before turning this in. Attach additional pages if needed.

DO NOT WRITE BELOW THIS LINE

Internship requirement for student:

Option I: Student must take 4800 and 4810

Option II: Student is waived of 4800; will take 4810 and an extra class

Option III: Student is waived of 4800 and 4810; is on 39 hour degree plan

Signature: ______________________________________________

Date:___________________________