Box 9, Folder 5, Document 21

Box 9, Folder 5, Document 21

....--------------------~-------------------------·
ATLAN TA
URBAN
In te rn ship Assignme nt Form
CORPS
r
Date
Urban Co rp s Rep res e nt at iv e
Name of Host Org aniza ti o n


Or g an i z at i o n a I Unit o f Proposed Assignment


Address
Assi gnment Locat ion ( : f differ en t f rom above)
Perso n Respons ibl e for
Intern s hip


Tit I e ____________________
Function of Organizational Unit


Teleph o ne No. ____________


Int e rnship Project Title (Outline o n Revers e Si de)
Begi nni ng Date

'--
Full Tim e
Ending Dat e
Part Tim e
Special Assig nm ent Cond iti ons
Approx.

Hours Per Week


Experience, Sk ills, Training or Other Qualificati o ns Desired:
Intervie w Req ueste~:
Name of I nt e rvie wer

Location
Phone-----------Req uest for assignment of an Atlanta Urban Corps intern in the descr i bed
position on the reverse side is hereby approved .
I hereby certify that the
assignment of an Atlanta Urban Corps intern into thi s position wi I I not result
in the displacement of a regular worker or imp air existing contracts for servic
es.
S i gna - ure
Title
Date
�Project Out Ii ne
De sc ribe 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 -------,-N,-a_m_e________
Title

Technical Representative
Name
Phone
Address
Phone
Address


Intern ---------,N~a_m_e___________
Address


Titl e
Co ll ege
Ph o ne


Approved For Atlanta Urban Corps _______________
Signature
Date
�