Form B – Three-credit internship (PEMC or RPTS minors)

Internship Form B: Description & Employer Contact (PEMC - 3 credits)

Complete this form immediately after accepting a position which you will use for your internship credits. The form is required before you can begin counting hours toward the required 200 hours for RPTS 484. Supervisor name and e-mail are used to request mid-term and final performance evaluations. If you have questions or need further information contact the RPTS Internship Coordinator, Mrs. Susan Scott, at
  • Name of company, agency or organization
  • Date Format: MM slash DD slash YYYY
  • Date Format: MM slash DD slash YYYY
  • Prefix = Mr., Ms., Dr., etc.; if you do not yet have supervisor information, e-mail it to Mrs. Scott ASAP.
  • Type a list or brief overview of the position's main duties based on the information you have received thus far.
  • Parent/Spouse/Significant Other

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