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Student Work Report

Directions: Fill in all the information requested. (Students who do not turn in their completed forms are given an "incomplete" in their grade reports. All "Incompletes" must be satisfied within 2 semesters or the"Incomplete" becomes and "Unsatisfactory" and is reflected on the transcript.)

Position Information:

Semester: Fall Spring Summer
Academic Year: 20 (e.g. 06)
Type: Internship Co-op
Student Information:  
Last Name:
First Name:
Middle Initial:
Major:
Degree(s) Offered (by Major):
E-mail:
Employer Information:  
Employer:
Street Address:
City:
State: (e.g. GA)
Zip:
Supervisor:
Salary: Per:  
Hours: Per:  

Additional Information:

Did you take any courses for credit while at work?

Yes No

If yes, what?

Will you return to work?:

Yes No

When?:

Describe briefly the general nature of your work and mention any specific duties or responsibilities assigned to you, and values you gained through this experience and any suggestions for improving the assignment.

How does your work assignment relate to your major?