INTERNSHIP COVER SHEET

Date: __________

Student's Name: ____________________________________________

Major: ____________________________________________________

Student's Address: __________________________________________

__________________________________________________________

Student's Phone:____________________________________________

Sponsoring Faculty Member: __________________________________

Site Supervisor's Name: ______________________________________

Title: ______________________________________________________

Address of Internship Site: ____________________________________

___________________________________________________________

Phone Number of Internship Site: ______________

I first reported to work on _____/_____/______

I shall complete my last day of work on _____/_____/______


I am earning $____________ per (hour, week, month, year) (circle one if applicable)