Agency Acceptance Form

Of Student Interns from Iowa State University's Department of Kinesiology

Name of Student *

Student email address *

Internship start date *

mm/dd/yyyy

Internship end date *

mm/dd/yyyy

Approximate number of hours per week *

Number of credits *

How many KIN/HS 485 credits will you register for?

KIN Academic Advisor Name *

Type to search

Paid/Unpaid? *

Description of Assignment *

Please outline the major responsibilities that the student will be assigned or upload internship description below.

File Upload

Drop your files here

Agency Name *

Agency Address *

Please enter street address, city, state, and zip code

Agency Supervisor Name *

Agency Supervisor Title *

Agency Supervisor phone number *

Phone

Agency Supervisor email address *

*

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