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Supervisor Service Agreement & Information
This form is to be completed by the Internship Supervisor & submitted for the Program Director's Approval for a 2022 Summer or Fall Internship or a 2023 Winter/Spring Internship
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* Indicates required question
Email
*
Your email
First Name of Student Intern
*
Your answer
Last Name of Student Intern
*
Your answer
Agency's Name
*
Your answer
Agency Address
*
Your answer
Supervisor's Name
*
Your answer
Supervisor's Title
*
Your answer
Supervisor's Phone Number
*
Your answer
Supervisor's email Address
*
This form must be submitted by the email address shown here.
Your answer
Please give a brief description of the role and responsibilities the student intern will have with your agency.
*
Your answer
Agreement of Supervisor
*
Click next to each item as reading & accepting the responsibilities of the participating Agency
Provide a supervised, quality, meaningful work experience for student intern
Ensure a safe work environment
Submit feedback form and sign off on student interns volunteer hours at end of internship
Required
Send me a copy of my responses.
Submit
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