LDCC Student Internship Confirmation

Student Name(Required)
Brock Email(Required)
Student Address(Required)
e.g. 2023 Spring
Agency/Organization Address(Required)
Field Supervisor's Name(Required)
Field Supervisor's Email(Required)
Please outline the timeframe (months you will be completing your internship) and the days/times you expect to attend the internship site. Also, include any additional notes that may be helpful for us to know for planning purposes.
Acknowledgments
As a student completing internship - you are responsible for meeting the employment requirements of the internship location - most commonly immunizations, and vulnerable sector police check. Please verify the requirements with with your placement location; I understand that I am responsible for obtaining:
This field is for validation purposes and should be left unchanged.