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Atlanta BEST ProgramTrainee Internship Application Form
Trainee information
Today"s Date

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Last name
First name
Email
Cohort
Institution
University Status
Residency Status
Internship Site Information
Name of Internship Partner organization
Description of the organization
Organization Address Street
City
State (Include country if not in US)
Intern Supervisor Information
Contact Name
Contact Phone
Contact Email
Location of Work
BELOW: If the internship site is the same address as the organization address, indicate "same as above"
Internship Site Address Street
Internship Site Address City
Internship Site Address State (Include country if not in US)
Internship Experience Information
Structure of Internship (48 minimum contact hours)
Start date:

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
End date:

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
How many weeks
Number of hours per week (including travel time, if applicable)
Compensation
If you will be paid- what percent %of your salary will be covered by the internship partner?
Additional Info:
Which Career Track does this correspond with ( http://gs.emory.edu/sites/best/tracks.html )
Trainee Responsibilities & M easurable Outcomes? (i.e. Bullet Points of number/type of activities you will complete, such as presentations, proposals, projects, etc
When appropriate, the BEST Program reserves the right to set additional requirements in conjunction with this worksite program, such as additional readings, journals, written assignments, etc. It is the responsibility of the trainee to meet with a BEST program team member and intern partner to determine policies, procedures, assignments, and evaluative measures, if any.
What are your expected learning outcomes?
How did you hear about this opportunity?
The below signatures will be collected when each stakeholder agree to the above experience. The BEST program signature is the first to sign off. Do not start collecting signatures until BEST approves this experience.
1) BEST Program Signature:________________________ Date: ______________________
Print Name:
2) Faculty Signature:________________________ Date: ______________________
Print Name:
3) Internship Supervisor Signature:________________________ Date:___________________
Print Name:
4) BEST Trainee Signature:________________________ Date: ______________________
Should be Empty: