ࡱ> NPM bjbj 4,m<8TT$prrrrrr$i@4```Fp`p```eA\F`\0````` :  Internship Organization Information This information will be used to document your organizations participation as an internship provider for a ̽ (KSC) student, and to describe the responsibilities of the internship assignment. Please return this form directly to the student intern who will contact a faculty supervisor and register this internship for college credit. Student/Intern Information Name: KSC Email: Contact Phone #: Student Signature ___________________________________________________________________________ Organization Information Name: Address: City: State: _________________ Zip: Phone Number: Web site: Intern Site Supervisor: Title: Department: Contact Phone: Email: Fax Number: Organization Signature: _________________________________________________________________ Internship Description Dates of Internship: (beginning) (through) Approximate Hours Per Week: Paid ($/hour): Non-Paid Briefly describe your organization, such as products or services the company provides, general size of the organization, mission and history of the company: Describe your expectations for the duties, roles, assignments, or projects of this student intern: If you have any questions about this student or the ̽ internship, please contact: Karen Balnis Service Learning & Internship Coordinator 603-358-2916  HYPERLINK "mailto:kbalnis@keene.edu" kbalnis@keene.edu     Success through Education and Experience &'(QкobUbUbHb;h7CJaJmHnHuh vCJaJmHnHuh4xCJaJmHnHuh?CJaJmHnHuh?h?CJaJmHnHuh\5CJaJmHnHu*hYh\5CJ$OJQJ^JmHnHu*hYh6l5CJ$OJQJ^JmHnHu*hYhi5CJ$OJQJ^JmHnHu*hYh4x5CJ$OJQJ^JmHnHuhYmHnHu jh9h9UmHnHu'( \ ] 2 !dh$d%d&d'dNOPQ]gd; !fdh]fgd4x  !gd\ $ !a$gdY ^`gdY$a$gd91 ŵn[H8nh4x5>*CJaJmHnHu%h4xh605>*CJaJmHnHu%h4xhHm5>*CJaJmHnHu"h4xh4x5CJaJmHnHuh4x5CJaJmHnHu%h;h4x5>*CJaJmHnHu%h;h;5>*CJaJmHnHuhYhYCJaJmHnHuh;CJaJmHnHuh4xCJaJmHnHuhY5CJaJmHnHu"hYh75CJaJmHnHu [ \ ] ^ w | } ϿϿ|iXH=hwCJmHnHuhkhw5CJmHnHu!h;h4x5>*CJmHnHu%h;h;5>*CJaJmHnHu"h4xh;5CJaJmHnHuhg#5CJaJmHnHu%h4xh4x5>*CJaJmHnHuh4x5CJaJmHnHuhY5>*CJaJmHnHuh4x5>*CJaJmHnHu"h4xh4x5CJaJmHnHuhY5CJaJmHnHu] ^ w  > a t u % e    !dhgdNYX  !dgdNYX2 !d$d%d&d'dNOPQ]gd;} ɹ㡑ɹqaaTDhkh4x5CJmHnHuh4x5CJmHnHuhwhw5CJmHnHuhh5CJmHnHuhh>*CJmHnHuhwh4x>*CJmHnHuh4x>*CJmHnHuhwCJmHnHuhkhw5CJmHnHuhw5CJmHnHuh;>*CJmHnHuhw>*CJmHnHuhwhw>*CJmHnHu   ! 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