Arizona Legislative and Government Internship Program Course Credit Form

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 [email protected] 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 ______School or Department 1 ______

Intern Course _____ Intern Course*_____ Intern Course _____** *Applicable if more than one internship course is taken in **Applicable if internship courses are taken in more than the same school or department. one school or department.

# of Intern Credits____ # of Intern Credits____ # of Intern Credits____ # of Intern Credits____ Academic Advisor Name (print) Academic Advisor Name (print) ______Academic Advisor Signature Date Academic Advisor Signature Date ______Faculty Member Submitting Your Grade Name (print) Faculty Member Submitting Your Grade Name (print) ______Faculty Member Submitting Your Grade ASU Email Faculty Member Submitting Your Grade ASU Email ______Student Signature Date 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 [email protected].