Employer Evaluation of Student Intern

Page 1 of 4 - General Information

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Student Name Student Name First Last
Student Phone Student Phone - ### - ### ####
Employer Name
Department
Address Address
Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country
Employer Phone Employer Phone - ### - ### ####
Employer Fax Employer Fax - ### - ### ####
Employer Email
Employer Web Site
Please describe in detail the nature of the student's work for the current term
Interned From Interned From / MM / DD YYYY
Interned To Interned To / MM / DD YYYY
Position Title
Rate of Pay
Supervisor Name Supervisor Name First Last
Supervisor Title
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