James Madison University Department of Political Science
INTERNSHIP APPLICATION
POSC 495/POSC 495W/PUAD 496/POSC 497 / PUAD 696
Before beginning any internship for which you wish to receive academic credit, you
must:
1. Complete this application and submit it to the faculty internship coordinator. Obtain an
override from the coordinator in order to register for the appropriate course.
2. Register and pay for internship credit.
Check the appropriate internship type:
☐ Political Science
☐ Public Policy and Administration
☐ Political Communication
☐ International Affairs
☐ Master of Public Administration
Check the term in which you are enrolled for the internship:
☐ Fall
☐ Spring
☐ Summer
Year _________
Student’s Name _____________________________ Student ID # ____________________________
Student Email _____________________________ Phone Number ___________________________
Local Address _______________________________________________________________________
Address during Internship ____________________________________________________________
Major _______________________________ Minor _________________________________________
Current GPA _________
UNDERGRADUATE ONLY: Please list courses completed as internship prerequisites
1. ___________________________________________________________________________________
2. ___________________________________________________________________________________
3. ___________________________________________________________________________________
4. ___________________________________________________________________________________
5. ___________________________________________________________________________________
Remember to:
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Turn this form into the faculty internship coordinator. Upon approval you will
receive an override notification to register for the requested course.
Register and pay for the internship credit
With your on-site internship supervisor, complete the Internship Training
Agreement form and return to the faculty internship coordinator no later than the
first week of the internship.
During the internship keep in contact with your faculty internship coordinator
and/or faculty member supervising the course.
Complete all assignments as assigned by faculty member supervising the course.
I understand the requirements of the internship and agree to comply with all internship
requirements and expectations.
Student Signature________________________________________________ Date ______________________________
James Madison University Department of Political Science
INTERNSHIP AGREEMENT
POSC 495/POSC 495W/PUAD 496/POSC 497/ PUAD 696
DIRECTIONS: The student's address, telephone number, and email address should be correct
for the semester the student is doing the internship. The work schedule on page two should be
completed in consultation with the internship provider. This agreement must be signed by the
student, the internship provider, and the faculty internship coordinator. This form should be on
file with the faculty internship coordinator by the beginning of the internship.
Student’s name
Student’s address
City
Student ID # __________________________________
Phone______________________ Email
State
ZIP
_
_
Internship provide (agency or office)____________________________________________________
Provider’s address____________________________________________________________________
City
State
Supervisor_____________________________ Phone
ZIP
_
Email_____________________
AGREEMENT
THE STUDENT AGREES TO:
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Fulfill his/her agreement to report to work on the assigned days and hours.
Understand that the internship provider must profit from the student's assignment in
order to justify working with him/her and providing him/her with internship training.
Perform all assigned tasks to the best of his/her ability.
Be available for consultation with the faculty coordinator.
THE INTERNSHIP PROVIDER AGREES TO:
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Provide the intern with practical work experience of professional relevance.
Assign work to the intern in accordance with courses studied at James Madison
University and to provide a variety of experiences to the student.
Be willing to provide a mutually agreed time for the faculty coordinator to meet with the
student intern and the internship provider.
Discuss with the faculty coordinator any misunderstandings or termination of the
internship before taking action.
Assist the faculty coordinator in evaluating the student intern's performance.
THE FACULTY INTERNSHIP COORDINATOR AGREES TO:
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Be available for consultation at mutually agreed times, with the other signatories of this
agreement.
Make every effort to visit, by mutually agreed appointment, the student-intern and the
internship provider at the work place. In some cases, a telephone conversation will
substitute for the visit.
Meet and/or talk with the internship provider to evaluate the student's performance.
WORK SCHEDULE:
Internship Start Date___________________ Internship End Date ___________________________
Anticipated Work Days (circle all):
MON
Anticipated Hours:
To _____PM
From _____ AM
TUES
WED THUR
FRI
SAT
SUN
Conditions or comments on work schedule (please note any anticipated schedule changes):
SIGNATURES
Student ___________________________________________________ Date: _____________________
Internship provider ________________________________________Date: _____________________
Faculty coordinator ________________________________________Date: _____________________
James Madison University Department of Political Science
STUDENT'S EVALUATION OF INTERNSHIP
POSC 495/POSC 495W/PUAD 496/POSC 497/ PUAD 696
This form will be shared with students who are considering internships. Do NOT write anything that
you would not be willing to share with other students.
Agency
Agency City
Agency State
Student's Name
Date
I. WORK ASSIGNMENT
A. Estimate the proportion of your time spent in work versus observation (circle one):
☐ 100% work
☐ 75% work
☐ 50% work
☐ 25% work
☐ 0% work
B. Did the tasks assigned you principally involve (check all that apply):
☐ Duties similar to those of regular personnel of the agency?
☐ Routine clerical tasks?
☐ Research?
☐ Frequent contact with personnel throughout the agency or office?
☐ Frequent contact outside the agency/office?
☐ Duties for which you possess adequate skills and knowledge?
C. Did the person(s) who supervised your work (check all that apply):
☐ Adequately describe the tasks you were asked to perform?
☐ Provide adequate supervision?
☐ Expect you to assume independent responsibilities?
☐ Offer assistance and guidance when requested?
☐ Take an interest in your internship?
☐ Show a willingness to provide additional information even when not related to your tasks?
D. Opportunities for learning (circle one):
Were you given adequate opportunity to learn through observation?
☐ Yes ☐ No ☐ NA
Were you given adequate opportunity to learn through doing?
☐ Yes ☐ No ☐ NA
Were you given adequate learning-focused feedback from supervisors? ☐ Yes ☐ No ☐ NA
II. ASSESSMENT – circle one answer only for the following questions
A. What is your evaluation of your internship as an educational opportunity?
☐ Excellent
☐ Good
☐ Fair
☐ Poor
B. Would you recommend other students be placed in this internship in the future?
☐ Yes
☐ No
☐ Maybe
C. To what extent did the internship assist you in clarifying your career goals?
☐ Excellent
☐ Good
☐ Fair
☐ Poor
D. To what extent did the internship assist you in achieving your career goals?
☐ Excellent
☐ Good
☐ Fair
E. COMMENTS
Describe any ways the internship could be improved:
Any other remarks or comments?
☐ Poor
James Madison University Department of Political Science
PROVIDER'S EVALUATION OF INTERNSHIP
POSC 495/POSC 495W/PUAD 496/POSC 497/ PUAD 696
Student’s Name _______________________________________________________________
DIRECTIONS: Please provide candid responses to the following items. This assessment of the
intern's performance will be a major factor in the determining the intern's grade for the
internship.
I. SPECIFIC TASK PERFORMANCE.
In the blanks below, please enter the four most important tasks or skills the student was called
upon to perform or use in the internship. Please indicate (1) the frequency with which the task
(or skill) was exercised, and (2) the level of proficiency achieved by the intern. In judging the
level of proficiency, consider the amount of time the student expended on the task (or skill) and
compare the intern's proficiency with that of others with similar training and experience. Please
circle your choices.
Task/ Skill A:
Frequency:
☐ Daily
☐ Weekly
☐ Monthly
☐ Rarely
Proficiency:
☐ Excellent
☐ Good
☐ Fair
☐ Poor
Frequency:
☐ Daily
☐ Weekly
☐ Monthly
☐ Rarely
Proficiency:
☐ Excellent
☐ Good
☐ Fair
☐ Poor
Frequency:
☐ Daily
☐ Weekly
☐ Monthly
☐ Rarely
Proficiency:
☐ Excellent
☐ Good
☐ Fair
☐ Poor
Frequency:
☐ Daily
☐ Weekly
☐ Monthly
☐ Rarely
Proficiency:
☐ Excellent
☐ Good
☐ Fair
☐ Poor
Task/ Skill B:
Task/ Skill C:
Task/ Skill D:
II. GENERAL WORK BEHAVIOR
Please assess the intern's general work behavior in terms of the following characteristics. Please
mark the appropriate column.
Don’t Know
Poor
Fair
Good
Excellent
Dependability
Follows Instructions
Accepts Responsibility
Shows Initiative
Interest in Work
Works Well with Others
Organizes Work
Perseverance on Task
III. AREAS OF IMPROVEMENT
If you were considering this individual for a job, what improvements in work habits,
interpersonal skills, and job skills would you want to see him/her overcome before being hired?
IV. OVERALL PERFORMANCE
If you were to assign a letter grade for this intern's overall performance, what grade
would you assign? Please circle one.
☐ A(=excellent)
☐B
☐ C
☐D
☐ F(=failure)
Print Supervisor's Name ______________________________________________________________
Signature______________________________________________________ Date________________