For-Credit Internship in Psychology (PSYC 41492) Request Form
Welcome to the Department of Psychological Sciences' Online For-Credit Internship in Psychology (PSYC 41492) Request Form.  This online form fully replaces the paper application version previously used.  Paper applications are NO LONGER being accepted.

Consult with your prospective internship supervisor to verify how many credit hours (i.e., between 1-6 credits) you and your internship supervisor have agreed to allow you to complete your for-credit internship experience as.  Every credit hour requires you to successfully intern at your internship site for a minimum of 45 hours by the end of the semester to successfully earn credit for our PSYC 41492 class. (1 credit = min. 45 hours; 2 credits = min. 90 hours; 3 credits = min. 135 hours; 4 credits = min. 180 hours; 5 credits = min. 225 hours; 6 credits = min. 270 hours).

In preparation for completing this form, we will be asking for the following information below regarding your internship site and internship supervisor:

1) Internship supervisor's first name, last name, and job title
2) Internship supervisor's email address & phone number
3) Internship location name & physical address
4) At least 3-4 duties/responsibilities/tasks you will be performing at your internship site and the time you will spend on each. You need to make it clear how this internship site is related to the field of psychology (or related fields open to psychology majors such as law, medicine, and human resources).

***IMPORTANT***  After completing this request form you must do two things. 1) Immediately email Dr. Jill Folk (jfolk@kent.edu) to let her know that you submitted a for-credit internship request online so they can review. 2) Have your supervisor complete the Internship Supervisor Form that can be found here: https://www-s3-live.kent.edu/s3fs-root/s3fs-public/file/PSYC%2041492%20Supervisor%20Form.pdf?VersionId=Lv5zwPmm7RWFA410Xi2twFkMbfMYOxSX. Email this form to Dr. Folk.

You can learn more about our entire Step by Step for-credit Internship in Psychology process online: https://www.kent.edu/psychology/internships-and-volunteer-opportunities   

As a reminder:

Fall 2024 for-credit Internship in Psychology (PSYC 41492 requests must be submitted via this form by Friday, August 16th, 2023

Spring 2024 for-credit Internship in Psychology (PSYC 41492 requests must be submitted via this form by Friday, January 12th, 2024  

Summer 2024 for-credit Internship in Psychology (PSYC 41492 requests must be submitted via this form by Friday, May 24, 2024  

After submitting this form, you will receive an automated kick-back email with your responses provided.  Store  this confirmation email safely for your personal records.

Dr. Jill Folk, the Department's Undergraduate Coordinator, will monitor all requests submitted and will follow-up with either you and/or your internship supervisor if more information is needed.  Registration will occur usually within a week after your submission.  You and your internship site supervisor will receive a confirmation email once registration occurs.

Please follow-up with Dr. Jill Folk (jfolk@kent.edu) after 1 week of submitting this form if you have not heard anything about your registration status in our Internship in Psychology (PSYC 41492) course before then.

PLEASE PROCEED TO COMPLETE THIS FORM ONLY IF...

(1) YOU HAVE READ & UNDERSTAND ALL THE INFORMATION ABOVE,

(2) YOU HAVE SECURED A FOR-CREDIT INTERNSHIP IN PSYCHOLOGY (PSYC 41492) WITH AN INTERNSHIP SUPERVISOR, &

(3) YOU HAVE ALREADY CONSULTED WITH YOUR INTERNSHIP SITE SUPERVISOR AND CAN PROVIDE ANSWERS TO ALL THE FIELDS BELOW
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电子邮件地址 *
Provide your FIRST & LAST NAME below. *
Provide your Student ID# below.  (This usually starts with either 810 or 811) *
Provide your cell phone number (or best phone number to reach you at) below. *
Which semester have you successfully arranged a for-credit Internship in Psychology (PSYC 41492) experience with an internship supervisor for? *
What is the start and end date of your internship? *
Where will you be interning?  Please specify the name of the organization & its physical address. *
What is the FIRST & LAST NAME of the individual who has agreed to supervise your upcoming for-credit internship experience? *
What is the TITLE of the individual who has agreed to supervise your upcoming for-credit internship experience? *
What is the BEST EMAIL ADDRESS to reach your internship supervisor at? *
What is the BEST PHONE NUMBER to reach your internship supervisor at? *
How many credit hours did your internship supervisor agree to supervise your for-credit internship experience for? (DO NOT GUESS!  Consult with your internship supervisor first before answering this question and submitting this form.) *
What are the 3-4 primary duties/responsibilities/tasks you and your internship site supervisor have agreed you will assist with throughout the semester, and how many hours a week will you spend on these duties? List and DESCRIBE those duties with the HOURS PER WEEK you are expected to spend on each. It must be clear that the duties are related to the field of psychology (or related fields open to psychology majors such as law, medicine, or human resources). *
Is the internship supervisor listed above a family member, friend, current work supervisor, or friend of yours? If no, simply type "No" below.  If yes, please detail relationship below. *
Before submitting your For-Credit Internship in Psychology (PSYC 41492) application below, remember you must email Dr. Jill Folk (jfolk@kent.edu)  immediately after submitting this request form so that she is aware you submitted a request and can review for approval.  Jot down the email addresses before submitting your request and click on the "I ACKNOWLEDGE" button below. Be sure to have your supervisor complete the Internship Supervisor Form. *
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