Sociology Internship Agreement Form
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:
 
 

 

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: