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INTERNSHIP GRANT
SUPERVISOR AUTHORIZATION FORM
INTERNSHIP INFORMATION (PLEASE HAVE SUPERVISOR COMPLETE)
Organization: ________________________________________________________
Address (include city, state, and zip): __________________________________________________
Supervisors name: ___________________________ Title: __________________________
Email: _______________________________ Phone: ________________________
____________________ has been hired as an intern and will complete an internship with our
student name
Please describe the students responsibilities and what you expect him/her to gain from this internship.
Would you recommend this student for the grant? If so, why?
SUPERVISOR: Please check this box to verify all information on this form is accurate.