Student Internship Request

Please read the PHSC Catalog/Handbook about the internship program before filling out this request form. It contains important information on prerequisites to the internship program, and general information about the program.

About You

First Name

Last Name

Student ID

Phone

Address

City

State

ZIP/Postal Code

About You

Home Campus

PHSC Major

Professional Goal

Business occupations in which you would like to have an internship experience in order of preference

First Choice

Second Choice

Third Choice

Additional Information

Information that may be helpful in selecting an internship site, (i.e., city, county, or area preferences / requirements, accommodation for your disability needs, daytime or nighttime restrictions, etc.)

Signature and Agreement

I am aware that participation in the internship program is contingent upon meeting minimum eligibility requirements as stated in the PHSC Catalog/Handbook, and that I am responsible to apply to internship websites order to find an internship site.

Electronic Signature

Date: May 14, 2026