| Student Name: | ________________________________ | Email: | ____________________ |
| Local Address: | ________________________________ | Phone: | ____________________ |
| Student ID: | ________________________________ | Major: | ____________________ |
| Class Status: | ________________________________ |
| Company Name: | ____________________________________________________________ |
| Website: | ____________________________________________________________ |
| Address: | ____________________________________________________________ |
| Phone: | ____________________________________________________________ |
| Job Title: | ___________________________ | Supervisor: | ___________________________ |
| Hours Worked: | ___________________________ | Supervisor Title: | ___________________________ |
| Credits Earned: | ___________________________ | Supervisor Email: | ___________________________ |
| Internship Begin and End Dates: | ______________________________________________ |
| Semester When CS 3996 Taken: | ______________________________________________ |
Final report and supervisor's letter of evaluation are due during finals week of semester indicated above.
Agreement Approved By:
| Intern: | ______________________________________________ | Date: | _________________ |
| Supervisor: | ______________________________________________ | Date: | _________________ |
| CS Dept: | ______________________________________________ | Date: | _________________ |