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| The signatures are to be obtained at the beginning of the internship
The Intern shall provide a copy for Dr. Withen & the Supervisor. |
| Professor's Name: Patrick Withen: Signature: ________________________ Date: ___________ |
| Address: Dept Social Sciences
Phone: 276-376-4526
1 College Ave Email: pwithen@virginia.edu UVaW Fax: 276-328-2447 Wise, VA 24293 |
| Book Title & Author chosen in consultation w/ the Intern, the Prof, & the Supervisor: |
| Intern's name: ______________________ Signature: ________________________ Date: ___________ |
| Address: |
| Phone: _________________________________________ Email: |
| Approximate dates Internship is to run: |
| Description of Internship Experience, written by the Intern
in consultation w/ Prof. Withen & the Supervisor:
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| Supervisor's name: ________________________ Signature: ______________________ Date: _________ |
| Name & Address of Agency, Company, etc.:
|
| Phone: _________________________________________ Email: |
| Important Dates: |
| Term in which Intern registers @ UVaW: Journal Due every 2 weeks from the Start Date: |
| Midterm Evaluation by Supervisor Due: |
| Final Evaluation by Supervisor Due: |
| Draft Proposal Assignment Due: |
| Term Paper Assignment Due: |
| Presentation Assignment Due: |