Form updated 1/6/2016

Internship Completion Form

Student Name: Student ID: Internship Organization: Contact at Internship: Address: City: State: Zip Code: Country: Province (If Applicable): Email: Phone:

Start Date: End Date:

Description of Organization (300 word limit):

Intern’s Title:

Internship Description (please outline your daily responsibilities at the internship; 300 word limit):

Compensation:

Paid Total Amount from Organization: Other Organizational Support:

Unpaid Contribution from the Friedman School: Other Non-Organizational Support:

Explain how the Internship met your expectations (300 word limit):

Please submit this form to Lori Ioannone (lori.ioannone@tufts.edu) as an attachment.