Practicum Internship Form - Saskatchewan

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Student Service Centre
1120 - 2010 12th Avenue
Practicum/Internship Information
Regina, Canada S4P 0M3
306-787-5620
1-800-597-8278
Fax: 306-787-1608
For Office Use Only
File No.
Student Information
- to be completed by student
Student’s Post-Secondary Education No.: __________________________
Student’s Full Name
: ________________________________________________________________
(please print)
Message to Students
If your program involves one or more practicum/internship placements, these placements may be
eligible for additional financial assistance. To be eligible:
• your practicum/internship placement(s) must be in a city/town other than where your school
is located;
• you have not received the maximum funding available for your period of study;
• you must apply for each practicum/internship placement prior to your period of study end
date; and
• you must be considered by your school to be a full-time student during the practicum/internship
placement.
If you will incur exceptional travel costs associated with your practicum/internship/exchange
program/field trip where airfare is the most reasonable form of transportation, please have your
school complete the reverse side of this form. You must provide documentation verifying the cost
of air travel from the airline or travel agency. The Ministry of Advanced Education may limit the
amount allowed for travel.
Practicum/Internship Placement No. 1
1. Dates:
from
__________________
to
__________________
(dd/mmm.yyyy)
(dd/mmm.yyyy)
2. Location: _______________________________________________________________________________
Distance (one-way) from school to practicum/internship location: _______ km (one-way)
Are you going to relocate to the city/town of your practicum/internship?
 Yes
 No
3. Income: Do not declare employment or self-employment income.
Total income (excluding employment income) received for the entire practicum/internship
placement: $____________
saskatchewan.ca/studentloans | 1-800-597-8278
AI149-0614

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