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MLP Proposal Form

This information will be examined by the MLD Director who reserves the right to deny or approve an internship placement and/or placement supervisor.

Student Name
Semester of Internship
Year of Internship
Check the specific course for which you are registering
Student's home address
Phone number
Alternate phone
Beeson Box #
Email Address
Address and phone number during internship (if different from above)
Placement where internship will occur
Address
Phone number
Position
Will you receive payment?
Start Date
Weekly Schedule
Briefly describe your anticipated activities
Name of Mentor/ Field Supervisor
Position
Time at this position
Address and phone (if different from placement information)
Email Address
Has this person supervised a ministry intern for Beeson Divinity School before?
Is so, whom did he or she supervise and when?