Name of Student_____________________________________________
Name of Internship Organization_________________________________
Location/Address of Organization________________________________
Name of Supervisor________________________ Phone:( )___________
Description of Experiences and Duties in Internship:
(It is understood that some of the answers to the following questions may change:)
1. Which semester or other period will the internship be served?_______
________________________________________________________
2. What is the estimated number of hours per week to serve?__________
3. How many academic credit hours will be taken?__________________
4. In which semester will academic credit be taken?________________
Remarks/Comments:
Agreed/approved:
_____________________________
Albert H. Gardner
Director, Advocates for Children
(301) 405-2814