(Graduate School for International Development and Cooperation, Hiroshima University）

Form 9
Certificate of Internship Completion
This is to certify that the internship has been completed as follows.

(Certifier/Supervisor)
Position/Name
(Signature or seal)

Date of issue (Month /Day /Year )

Name of intern

Period: From (Month/Day/Year) to (Month/Day/Year)

Period of internship (Number of days worked ____days→counted as 8 hours/day)
Late arrival: ___times, Early dismissal: ___ days

Outline of internship

Special remarks
regarding the
intern’s attitude,
discipline, or
cooperativeness
during internship

Personal evaluation

Grade
A: Excellent B: Good C: Average
Please put
percentage, if it is D: Below Average E: Poor
more appropriate

Other comments

Personal information provided on this form will be used for the purpose of procedures of assessment of the intern student’s
‘Internship’ course only.