School of Business Internship Agreement

Student Information

Student ID:
Name:
Address Line 1 :
Address Line 2 (Optional):
City:
State:
Zip:
Phone :
Email:

Employer Information

Company Name:
Address Line 1 :
Address Line 2 (Optional) :
City:
State:
Zip:
Phone :
Fax
Employer's Email:
Supervisor's Email
Supervisor's Name and Title
Supervisor's Job Title

Student Job Title
Beginning Date
Internship Total Hrs Worked: (60 or more hours required)
Ending Date:
Hours Worked Per Week:
Is this a Paid Internship?	Yes No If so, Student Hourly Salary: Does your dog bite? yes no Does your dog chase his or her tail? yes no Does your bird sing? yes no Does your bird talk? yes no

Stipend:

Name of person submitting form:

By clicking the submit button, you are verifying that all above information is correct and giving the SIUE Career Development Center permission to share this information with the SIUE School of Business.

Print-Friendly Version (pdf)