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PEI/Grand Challenges Internship Supervisor Commitment Form

2014 Student-Initiated Internships

Priority Application Deadline: February 21, 2014.

In order for a Princeton University student to receive University approval for an internship, the person who will be the student's primary work supervisor during that internship must complete this form. If you have any questions about using this online form, please contact Lorin Romeo Romay at (609) 258-7158 or peintern@princeton.edu.

Note: If you would like to retain a copy of the completed application for your records, please print a copy using your computer's browser before clicking on "Submit" at the bottom of this page.


A. Intern

Last Name:
First Name:

B. Organization

Organization:
Website:
Type of Organization:
For example: NGO, government office
Focus of Work:
For example: health, environment, public policy, advocacy

C. Primary Work Supervisor

Last Name:
First Name:
Title:
Department/Program:
Address:
Phone:
E-Mail:

D. Secondary Work Supervisor (If Any)

Last Name:
First Name:
Title:
Department/Program:
Address:
Phone:
E-Mail:

E. Internship

Title of Intern's Position:
Internship Start Date:
Internship End Date:
Internships must be a minimum of 8 contiguous weeks in length, full-time (35 hours per week minimum).
Work and Responsibilities:
Describe the intern's work in this position; please be specific, addressing areas of responsibility, projects, tasks, and other duties.
Learning Outcomes:
Describe skills, knowledge, and perspectives you expect the intern to acquire.
Expenses the Intern Might Incur:
Include expenses other than living, travel to and from the internship location, and other local transportation costs.

F. Statement of Commitment

As the primary work supervisor, I agree to be available to the intern for the duration of the internship and to support the intern in his or her learning objectives.
Date: