Box 9, Folder 5, Document 21

Box 9, Folder 5, Document 21

ATLANTA URBAN CORPS Internship Assignment Form

REE Rees ees



Urvan Corps Representative Date



Name of Host Organization



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

éS.



Signature Title Date




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