| Name of Intern: | ||
| Name of Supervisor: | ||
| Discussed tasks with intern: | Signature of Supervisor: ______________________ | |
| Office & Position of Supervisor: | ||
| Address of Supervisor: | ||
| Telephone of Supervisor: | ||
| E-mail address of Supervisor: | ||
| Duties of Intern:
(check off all that apply, adding or modifying as needed; intern & supervisor should discuss these in advance.) |
appropriate office attire
reception writing reports writing press releases writing letters other (specify)
|
casework for constituents
gathering statistics note-taking in meetings giving tours for guests other (specify) |
| Additional educational experiences for intern: | Field trips
Guest speakers other (specify) |
Meeting with leaders, etc
Briefing by supervisor other (specify) |
| Dates of Internship: | From: | To: |
| Hours per week: | ____ x ___ weeks = | Total hours: |
| For Faculty use only: | weekly journal received
(tasks, observations) |
term paper of analysis and reaction (about ten pages) |
| Report from supervisor received. | Supervisor's grade (circle one):
A A- B+ B B- C+ C C- |
|
| Intern debriefed by Faculty member (date): | Faculty member's grade (circle one):
A A- B+ B B- C+ C C- |
|