PLACEMENT CONFIRMATION

(Complete & Print)

Student Name:
Address: 
Telephone:                
Campus Box:  Advisor: 
Course Number:  Credit Hours: 
Semester & Year:   

INTERNSHIP ASSIGNMENT

Organization:
Address:
Mentor:
Telephone:  Fax: 
Schedule:  Days & Hours per week:
Monday Tuesday Wednesday Thursday Friday

OUTLINE OF PROPOSED INTERNSHIP PROGRAM

Internship Approvals

________________________________________
Organization Mentor, position		 _______________
Date
________________________________________
Music Faculty Internship Advisor		 _______________
Date
________________________________________
Music Department Chair		 _______________
Date
________________________________________
Student Intern		 _______________
Date

c:  Organization Mentor, Music Faculty Internship Advisor, Music Department Chair, Student Intern