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2025 Internship Stipend 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 11, 2025. If you have any questions you can contact us at
scholars@jkcf.org
. Your signature below verifies that the information shared in this report is true and accurate.
Scholar Name:
Organization Name:
Organization Address:
Was the internship in person, virtual, or hybrid?
Was the internship in person, virtual, or hybrid?
In person
Virtual
Hybrid
Do you confirm that the Scholar completed their full-time summer internship under your supervision?
Do you confirm that the Scholar completed their full-time summer internship under your supervision?
Yes
No
If no, please explain
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