Internship Approval Form

[This form is for students requesting approval of their proposed internship.

This form must be approved prior to starting an internship]

Internee Name: ________________________

Date:

Reg. No.____________________

______________________________

Phone: ______________________________
E-mail: _______________________________
Internship
Organization: ______________________________________________
Address:

________________________________________________

Host Supervisor (including title): ________________________________

Host Phone: _____________
Internship Start Date: ________

E-mail __________________________
End Date ________

Total Expected Days: _____ (minimum six weeks)

Internee Signature: _____________________________

Supervisors Name & Signature: __________________________

Internship In charge Signature _____________________