UG Site Information Sheet
Department of Recreation, Park and Tourism Administration
This information is needed before an agreement can be initiated
Student Name
*
First Name
Last Name
WIU ID #
*
Date
-
Month
-
Day
Year
Date
WIU Email Address
*
Personal Email Address
*
Address during Internship
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Home or Cellphone Number during Internship
*
Please enter a valid phone number.
Name of Internship Agency
*
Agency Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Agency's Phone Number
*
Please enter a valid phone number.
Agency's Email
*
example@example.com
Name of Agency Supervisor
*
First Name
Last Name
Title of Agency Supervisor
*
Beginning Date of Internship Agreement
*
-
Month
-
Day
Year
Date
Ending Date of Internship Agreement
*
-
Month
-
Day
Year
Date
Please attach the job description (or list of duties).
*
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