Internship Description Form
must be completed and sent to the coordinator before the end of the first week of the internship.

name _____________________________________

date ___________________

phone (during internship)__________________

company name _____________________________

company address ___________________________

_________________________________________

starting date ____________ ending date ____________

hourly pay/salary ___________________________

What wil be your responsibilities. What is the approximate time to be spent in each area:

Company approval:

your signature ____________________________ date __________

supervisor's signature _______________________ date __________

supervisor's name ________________________________________

supervisor's title__________________________________________

Coordinator's Signature _____________________ date __________