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California Lutheran University
About
About
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Facts at a Glance
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PLTS Internship Arrival Form (Word and Service)
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Student Contact Information
First Name
Last Name
Pronouns
Email Address
Cell Phone Number
Home Address
(while on internship)
Country
Street
City
Region
Postal Code
Period of Internship
Start Date
Start Date
January
February
March
April
May
June
July
August
September
October
November
December
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
2023
2024
2025
2026
2027
2028
2029
2030
2031
2032
2033
2034
2035
2036
2037
2038
2039
2040
2041
2042
2043
2044
End Date
End Date
January
February
March
April
May
June
July
August
September
October
November
December
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
2023
2024
2025
2026
2027
2028
2029
2030
2031
2032
2033
2034
2035
2036
2037
2038
2039
2040
2041
2042
2043
2044
Internship Information
I am serving a 2-site internship
I am serving a 2-site internship
Yes
No
Congregation Information
Congregation Name
Country
Street
City
Region
Postal Code
Phone
Website
Congregation Supervisor's Contact Information
Name
Pronouns
Email
Phone
cell
office
Congregation Supervisor Meetings
Day
Time
Frequency
Congregation Internship Committee
Chair Name
Pronouns
Email
Phone
cell
office
home
Schedule/Frequency of Internship Committee Meetings
Organization
(or 2nd congregation)
Information
Organization (or 2nd congregation) Site
Country
Street
City
Region
Postal Code
Phone
Website
Organization
(or 2nd congregation)
Supervisor's Contact Information
Name
Pronouns
Email
Phone
cell
office
Organization
(or 2nd cong site)
Supervisor Meetings
Day
Time
Frequency
Congregation
Financial Commitments
Monthly Stipend Amount
Business Mileage Reimbursement/mile
If site assists with FICA payments, to what degree? (dollar amount):
Amount toward Internship Administrative Fee of $1500
Additional Comments
Organization
(or 2nd Congregation)
Financial Commitments
Monthly Stipend Amount
Business Mileage Reimbursement/mile
Amount toward Internship Administrative Fee of $1500
Additional Comments
Housing
Is housing provided?
Is housing provided?
Yes
No
Please describe the housing arrangements.
Include information regarding which congregation or organization (or combination thereof)
is providing the housing and the specifics of the housing itself.
Submit