Student Development Internship Worsheet

  1. Educational Information:

  2. Higher Education (College and/or University, or equivalent)

  3. Reference: Indicate the name of your academic adviser or the Dean of the Faculty who can recommend you for the internship and describe your character and qualifications.

  4. Insurance:I hereby confirm that I hold a health/accident insurance policy:
  5. In case of emergency notify:

  6. I certify that the statements made by me in answer to the foregoing questions are true, complete and correct to the best of my knowledge and belief.