Campbell University

Department of Government, History and Justice 

Application for an Internship (Govt/Hist/Crim 454) 

General Information

Name ___________________________________________  Date_______________

Student ID number ____________________  Soc. Sec. Number;____________________

Phone (where you’ll be reachable)  (        )_______________________

Address (Box # in the Creek if you have one) ____________________

_________________________________________________________

_________________________________________________________

Academic Information

Student’s Advisor__________________________________________

Student’s Major____________________________________________

Classification:    Senior     Junior    Sophomore    Freshman

Cumulative GPA __________________  Major GPA _____________         

Departmental courses taken this year______________________________

                                                                                                                       

Course load in semester you’ll be performing the internship _________           

Work Site Information

Contact person_____________________________________________

Phone # __________________________________________________

Address __________________________________________________

Agency name (location) _____________________________________