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Student Employee Student Employer
_____________________________________ _______________________________________
Name Phone Number Intern Supervisor Phone
Number
__________________________________________
____________________________________________
Address
Company
__________________________________________
____________________________________________
City State ZIP Address
___________________________________________
___ Fresh
____ Soph
____ JR _____ SR City State Zip
Pay
Period Ending (MM/DD/YY):__________________ Hourly Rate to be Paid: $__________________
INSTRUCTIONS: Please fill out completely and return with
signature every 2 weeks. Please
review Internship Policies
if you
have questions, or call 228-5439. Hours
must be recorded on day worked. Please record minutes as fractions.
Example:
4 hours and 15 minutes= 4.25 hours.
Please sign and date at bottom.
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