Supervised Ministry 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*
Practicum format:*
If completing CPE, which term?
Phone number*
Alternate phone
Beeson Box #
Email Address*
Placement where internship will occur*
Phone number*
Will you receive payment?
Start Date
Weekly Schedule
Briefly describe your anticipated activities
Name of Mentor/ Field Supervisor*
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?*
Please answer the simple math question below to submit the form.
2 + 2 =