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Memorandum of Agreement
IMPORTANT NOTE: This form must be completed and approved by the internship coordinator before your internship begins.
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Last name, first name
Your answer
Email
Your answer
Phone
Your answer
W#
Your answer
Current major (include concentration if applicable)
Your answer
Current minor (if applicable)
Your answer
Current GPA
Your answer
Year in school
Freshman
Sophomore
Junior
Senior
Other:
Clear selection
Internship Title
Your answer
Cooperator/supervisor name
Your answer
Cooperator/supervisor address
Your answer
Cooperator/supervisor phone
Your answer
Cooperator/supervisor email
Your answer
Beginning date of internship
MM
/
DD
/
YYYY
Ending date of internship
MM
/
DD
/
YYYY
Name of academic advisor
Your answer
Academic advisor email
Your answer
Semester you wish to enroll in ANSC 4550
Spring
Summer
Fall
Clear selection
Year you wish to enroll in ANSC 4550
Your answer
Provide a brief description of your internship
Your answer
Provide a description of the responsibilities of the cooperator/supervisor (benefits, salary, etc.)
Your answer
Submit
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