MLP Proposal Form

Student Name
Semester of Internship	Fall Spring Summer
Year of Internship
Check the specific course for which you are registering	DVML 550 Ministry Leadership Practicum I (1 credit) DVML 650 Ministry Leadership Practicum II (1 credit) DVML 750 Ministry Leadership Practicum III (1 credit) DVML 751 CPE-full unit (6 credits) DVML 551 CPE-half unit/first semester (3 credits) DVML 651 CPE-half unit/second semester (3 credits)
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?	Yes No
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?	Yes No
Is so, whom did he or she supervise and when?

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