Wellness - Expectation Statement Worksheet A
This form will be used to develop a list of expectations and objectives for this internship experience.

The Intern and Internship Supervisor should work together to develop a list of expectations and objectives for this internship experience. The list should address specific internship objectives, responsibilities, and projects; special projects; dress code; anticipated starting date; anticipated ending date; work hours; compensation; and any other pertinient information that explains what the internship will involve and ask of the intern.

This assignment should be completed by the Intern and the Intership Supervisor and submitted through this site. If you prefer to mail or fax the form please send it to the Program Director of Wellness Management at the Fisher Institute for Wellness and Gerontology one month prior to the student beginning the internship experience (this allows time to process the required University contracts).

Items with an * indicate a required field.
Intern Information
Today's Date *    
Due Date *    
Intern's Name *
Address *
City *
State *
Zip *
Country
Phone *
Fax *
Email *
 
Internship Supervisor Information
Internship Supervisor's Name *
Title *
Internship Site *
Address *
City *
State *
Zip *
Country
Phone *
Fax *
E-mail address *
Specific internship objectives, reponsibilities, and projects: *
Special Projects: *
Dress Code: *
Anticipated Starting Date: *    
Anticipated Ending Date: *    
Work Hours: *
Compensation: *
Any other pertinent information that explains what the internship will involve and ask of the intern:
Internship Supervisor has approved worksheet *  Yes
  No
Date *