Internship Reporting
Reporter Name
Student Name
Class Standing at time of internship
Please select...
First Year
Sophomore
Junior
Senior
Graduate Student
Major
Organization Name
Organization Address
Location of Internship
(if different from address)
Site Supervisor
Contact Person
Contact Phone
Contact Email
Internship Start Date
Internship End Date
Description of Internship
Semester of Internship
Please select...
Spring
Summer
Fall
Winter
Year
For Credit?
Yes
No
Faculty Supervisor
Course Number
Number of Credits
Compensation?
Paid
Not Paid
Requires a background check?
Yes
No
Requires faculty approval?
Yes
No
Name of Faculty
Comments
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