UNIVERSITY OF PITTSBURGH
DEPARTMENT OF COMMUNICATION, 1117 Cathedral of Learning, Pittsburgh, Pennsylvania 15260
INTERNSHIP AGREEMENT: Phone 412-624-6567 Fax 412-624-1878

Student's Name ________________________  Social Sec. No. ______________  Year ___

Major _______________  Total Credits Earned ____ QPA ____  Term of Internship_______

Local Phone ___________________ Preferred Email Address _______________________

I. Company/Organization Name ________________________________________

Supervisor's Name and Title (Please Print) _______________________________________

Company Address ____________________________ City ___________ State _____ Zip___

Phone ___________________ Fax ________________________ Email ___________________________

Describe the responsibilities of the intern. __________________________________________

______________________________________________________________________________________________________

______________________________________________________________________________________________________

______________________________________________________________________________________________________

______________________________________________________________________________________________________

______________________________________________________________________________________________________

Describe how you will supervise and evaluate the intern. _____________________________

______________________________________________________________________________________________________

______________________________________________________________________________________________________

______________________________________________________________________________________________________

Dates of internship _________ to __________  Hours per week ______  Compensation _______

Supervisor's Signature ___________________________________________ Date ____________

II. FACULTY sPONSOR: List the requirements for the academic component of the internship. Include
what can be expected to be learned from this internship. _____________________________________
_______________________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________

Credits for internship ____(1 to 3) Faculty Sponsor's Name (Print)________________________________

Faculty Sponsor's Signature _____________________________________ Date: ______________

Student's Signature ___________________________________ Date____________

Department Advisor's Signature _____________________________ Date ___________