Practicum Student, Employer Info
If you feel that you have a legitimate internship site/job, use this form to fill out all necessary information from your employer. Be sure to send me your schedule as soon as you know what it is. PRINT A COPY OF THIS FORM & KEEP IT IN YOUR BINDER.
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Your Name *
Your email address. *
Your phone number. *
What is the company name or individual you are working for or planning to work for? *
What is the name of the individual who will be supervising you? *
What is the email address of the individual who will be supervising you? *
What is the phone number of the individual who will be supervising you? *
What is the address of the company/individual you will be working for? *
How many hours a week will you be working for this company? *
What are the duties and responsibilities of this position? You should ask your supervisor to give you this information. Your supervisor can email this information directly to: terry.lutz@kctcs.edu, if you wish. *
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