Supervisor Service Agreement & Information
This form is to be completed by the Internship Supervisor & submitted for the Program Director's Approval
Name of Student Intern *
Your answer
Agency's Name *
Your answer
Agency Address *
Your answer
Supervisor's Name/Title *
Your answer
Supervisor's Phone Number *
Your answer
Supervisor's email Address *
This form must be submitted by the email address shown here.
Your answer
Please give a brief description of the role and responsibilities the student intern will have with your agency. *
Your answer
Please describe any training the intern will receive and approximate volunteering schedule. *
Your answer
Agreement of Supervisor *
Click next to each item as reading & accepting the responsibilities of the participating Agency
Required
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