EmailMeForm
Internship Enrollment Status Form
This form is used to verify the number of contact hours in your internship. It will be emailed to your internship advisor for confirmation. Please be sure to include their name and email.
Name
*
First
Last
LHU Student ID Number
*
Email
*
Phone
*
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-
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-
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Degree Seeking
*
Please select
UNDG
GRAD
Major
*
Internship Location
*
Internship Hours
*
Length of Internship (weeks)
*
Internship Start Date
*
MM
/
DD
/
YYYY
Internship End Date
*
MM
/
DD
/
YYYY
LHU Internship Advisor Name
*
First
Last
LHU Internship Advisor Email
*
Electronic Signature
*
By typing your name in the Electronic Signature box above, you are confirming you are the student listed above. You authorize Lock Haven University to award your financial aid.
Date Signed
*
MM
/
DD
/
YYYY