SUMMARY & EXIT CHECKLIST

This form has purpose to assist internee & mentor in completing all process/step in the internship program. All fields is
mandatory and should be completed and submitted to HR on or prior to internee's last day of program.

Student Name : Program :

Program Period : Division :

Research Topic / : Mentor Name :

Activities
Manager Name :

PROGRAM SUMMARY
During this program, Interns has doing these activities in order to support the research and/or to give working experiences, as
follows:

First week/month Second week/month

1 1

2 2

3 3

Third week/month Forth week

1 1

2 2

3 3

EXIT CHECKLIST
On Mentor side: On HR side:
Final report has presented to Mentor & respective Internee has submitted written final report (approved by
Manager on_________________________________ Mentor & respective Manager)

Final report & its content has been submitted and Internee has return identity/access card
approved by Mentor & respective Manager

Internee has return Company's computer/laptop, which Internee has return all Company's property (Library
provided based on Department request - If any Books, etc) - if any

Internee has submitted final timesheet

Notes:

signature

Internship Mentor Manager [HR-Internship staff)

This form must be returned to HR&R Department for filing on personal file and a copy retained by the work unit.