Box 9, Folder 5, Document 21

ATLANTA URBAN CORPS



Urvan Corps Representative Date



Name of Host Organization

Internship Assignment Form

REE Rees ees



Organizational Unit of Proposed Assignment



Address



Assignment Location fif different from above)





Person Responsible for Internship



Title Telephone No.



Function of Organizational Unit









Internship Project Title (Outline on Reverse Side)





Beginning Date Ending Date





Full Time Part Time Approx. Hours Per Week

Special Assignment Conditions







Experience, Skills, Training or Other Qualifications Desired:







Interview Requested: Name of Interviewer











Location Phone
Request for assignment of an Atlanta Urban Corps intern in the described
position on the reverse side is hereby approved. | hereby certify that the

assignment of an Atlanta Urban Corps intern into this position will

not result

in the displacement of a regular worker or impair existing contracts for servic



Signature Title

Date

éS.








Project Outline

Describe briefly in terms of how the task serves the purposes of the
organization:

Specific objectives of internship project:

Planned orientation and approaches:



To Be Completed By Atlanta Urban Corps

Educational Counselor















Name Title
Address Phone
Technical Representative

Name Title
Address Phone
Intern

Name College

Address Phone







Approved For Atlanta Urban Corps



Signature Date