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,l INTERNSHIP ATLANTA URBAN CORPS 30 Courtland Street, N.E. Atlanta, Georgia 30303 ASSIGNMENT 3 IN TERN NO. 4 INITIAL ASSIGNMENT .. NAME REASSIGNMENT A PART TIME ADDRESS
SUMMER
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AGENCY
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COORDINATOR
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NATURE OF' ASSIGN MENT
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ADDRESS
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TO BE COMPLETED BY AGENCY COORDINATOR
ST UD ENT
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I MME DIAT E S U PCR VI S O R
D A C C E PTED
AS S IGNMEN T
(NAM E OF CENT E R)
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ASSIGNMENT HOURS
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TO
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UNACCEP T ABLE
R E MAR K S
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TU E S
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THURS
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- - - - - - - - -- -- -. . - - + - - - -- - -- -- ST AR TIN G DA T E 20 - - - - - - - - - -- S IGN A T UR E O F' C OOR D INATOR 2 1 - - - - - - - -'-- ~- - ~- - - - -- - -- ·- - - -- - - - - - - - -- - - - - I de cline th is a ss ign men t and wi s h lo be rea ss igned bec au se :
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D I w 1sh t o w it hd ra w frort;, t he U R BAN C ORPS. (see it e m 5 on reve rse ) WH I T E ,C ANA•R Y I!< GR E EN - URBAN CORPS PIN K - AG ENC Y COO R DINA TO R BLU E - I NTE ~ N S RE C O RD 0
..-~SAT TO BE COM PLETED BY INTERN IF DECLINING ABOVE POSITION D I S TRIBU TION : -' -~ SUN D 0 AGENCY COORDINATOR FOR M U C- 4 9 / 67 M - 8 22 2 7 8 �INSTRUCTIONS: TO URBAN CORPS INTERN: l. Th is is your intern ass ignment. In accordance with your stated preference, you have been assigned to the position described in Box 11 on reverse ·· side . 2. You MUST contact the COORDINATOR named in Box 8 immediately to arrange for an interview, at which time the exact nature of your assignment will be outlined. 3. Bring all five copies of th i s form with you to the interview. DO NOT SEPARATE THEM . At your interview, the agency coordinator will fill out Boxes 13 through 21 . 4. The agency coordinator will retain the pink copy . You will remove the blue copy for your records. You MUST return the other three copies to THE · ATLANTA URBAN CORPS, 30 Courtland Street, N.E ., Atlanta, Ga. 30303: IMPORTANT--NO PAYROLL WILL . BE PROCESSED UNTIL THES_E FORMS ARE RECEIVED BY THE URBAN CORPS OFFICE. 5. If, before the interview, you decide that you do not want this assignment, check space in Bo,c 22 and state your reasons. If you w i sh to withdraw from the URBAN CORPS, check the space in Box 23 . THEN RETURN ALL COPIES TO THE URBAN CORPS. TO AGENCY COORDINATOR: 1. The intern who br ings this form has been assigned to the specific position whose Ass ignment number appears in Box 10 . 2. If you accept th e intern for the assigned position, complete Boxes 13 throughll.. 3. Reta in the PINK copy for your records . 4. RETURN THE REMAINING FOUR COPIES TO THE INTERN. 5. If the intern is not acceptable or declines the pos ition, check the appropr iate space in Box 13 and return all f ive copies of the form to the intern. NOTE : ( If there are any questions regarding placement procedure, please feel free to call the URBAN CORPS at 524-8091 or write : AT LANT A URBAN CORPS 30 Courtland Street, N. E. Atlanta, Georgia 30303 �
