CENTRAL CONNECTICUT STATE UNIVERSITY
CENTRAL CONNECTICUT STATE UNIVERSITY
Department of Counselor Education & Family Therapy
Student Development in Higher Education
Application for Academic Internship – CNSL 592
NAME: __________________________________________ ID. # ___________________________
DAY TIME PHONE: _______________________________ DATE: _________________________
E-MAIL ADDRESS: ___________________________________________________________________
Eligibility Requirements (due at time of first class):
1. Academic Internship agreement with college/university
2. Proof of professional liability insurance
3. Taskstream account
NOTE: The forms are available in the spinner outside of the office (Barnard 221).
Deadlines:
March 15 Fall and Spring Academic Internship
I wish to apply for admission into CNSL 592: Internship in Student Development in Higher Education, for the following semesters:
Semester: Fall & Spring Academic Year ____________
Advisor Approval
I have reviewed the student’s file, including the Attitudes & Attributes survey and transcripts, and certify that the student is ready to enter CNSL 592: Internship in Student Development in Higher Education.
_________________________________________ ______________
Signature of Advisor Date
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