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2021 Supervisor Completion Form
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Thank you for sponsoring an internship for one of our undergraduate Scholars. Please complete the information below and submit by September 14, 2021. Your signature verifies that the Scholar completed the required internship hours. You can reach out to scholars@jkcf.org if you have any questions.
Scholar Name:
Organization Name:
Organization Address:
How many hours did the scholar complete during the internship?
160 - 239 hours
240 - 319 hours
320+ hours
Optional question to help us with future planning:
Are you interested in supervising Cooke Scholars for internships in the future?
Optional question to help us with future planning:
Are you interested in supervising Cooke Scholars for internships in the future?
Yes
No
Would you be interested in attending an event where your intern(s) will give a presentation on the work they do under your supervision along with other Cooke Scholar interns from other sites? Please check all that apply.
Would you be interested in attending an event where your intern(s) will give a presentation on the work they do under your supervision along with other Cooke Scholar interns from other sites? Please check all that apply.
Yes, if it's virtual
Yes, and I'm willing to travel
No
Supervisor's Name:
Supervisor's Title:
Supervisor's Phone Number:
Supervisor's Email Address:
Supervisor's Electronic Signature:
Date:
Submit