Request For Approval Of Internship Page 2

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Organization at which Internship is Located _________________________________________________________________________________
Address _________________________________________________________________________ Phone _______________________________________
Internship Supervisor’s Name _________________________________________________________________________________________________
Title and Summary Description of the Project: _______________________________________________________________________________
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Relationship of the Internship to the Student’s Educational Program and Objectives: ___________________________________
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Student’s Background Pertinent to the Proposed Internship: ______________________________________________________________
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Detailed Outline of the Proposed Internship (Attach additional pages as necessary)
Title ______________________________________________________________________________________________________________________________
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Objectives _______________________________________________________________________________________________________________________
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