Spring 2005 Semester: ITFN 2012; CRN 23020
Student Name: Date:
Site Supervisor: Job Title:
Site Supervisor’s Company:____ Phone:
E-mail:
1. General:
Written Report. Each “student/intern” will independently prepare a professional written report describing their most meaningful “Learning Objective” which was stated at the beginning of the semester and identified in your Experiential Learning Agreement. Restate the “Learning Objective” and use the following criteria for your report:
+ Cover Page +Single Space
+ 1,000 Words (minimum) + Due Date: April 29th, 2005 (Extensions by email request)
2. Intern Work Hours.
Log (Time) Records: Each student/intern will update and complete their Internship Log (attachment) to accurately reflect total hours spent in the performance of their Learning Objectives. Site supervisors will “sign-off” on this document which will be submitted as an attachment to student’s Final Report.
3. Acknowledgement
By signing below, the student/intern and site supervisor/manager agree to the items described above.
Site Supervisor’s Name/Title Student/Intern’s Name
Signature/Date Signature/Date
The signed original of this agreement and the following attachment should be returned to the CCSU, Attn: New College for Economic & Community Development:
· Attachment A: CCSU’s Internship Log
Once all required signatures have been obtained, the student/intern should submit the above original documents as stated and provide a copy to the site supervisor if requested.
Final Rpt Form 1/04/05