History 680/880

Date _________________________

Name _________________________________________________________________________

Address _______________________________________________________________________

Home phone ________________________ Work phone ________________e-mail_{______________}

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Placement Preference: (describe the sort of work you would prefer to do and the sort of agency in which you would prefer to work; provide any other information that would be helpful to the internship coordinator in finding an appropriate placement)

Statement of Purpose (state your reasons for wanting to do an internship, including your learning objectives):

QUALIFICATIONS

Major ______________________________ Minor ______________________________

Class standing _____________________ Grade point average ________________

Courses you have taken that have provided appropriate background [be certain to indicate whether you have taken History 300, 302, 450, 426, 427, 428, or 700 (graduate students only); indicate the grades you received]:

Other relevant experience (list work you may have done in a similar setting):

 Special skills (ability to read foreign languages, to do computer programming or word processing, to operate special equipment, etc.):

References (list two SFSU faculty members who can provide an evaluation of your abilities):