ࡱ> ,.+  bjbj 4eeppppp Kkkk,Cpkkkkppk ppkj@N/72u.60K>,jpjDkkkkkkKkkkkkkkkk 6:   University of Wisconsin Milwaukee Department of History Verification of Internship TO BE COMPLETED BY STUDENT Name of Student: Date:  Telephone Number:  Number of Internship Credits:  Do you have a disability which will require accommodations by the agency? YES NO If YES, have you discussed this issue with the agency? YES NO Are you presently registered with the student accessibility center? YES NO TO BE COMPLETED BY AGENCY SUPERVISOR Name and Address of Agency or Organization: _____________________________________ ____________________________________________________________________________ Name of Supervisor(s): _________________________________________________________ Supervisor/Agency contact information: ___________________________________________ Briefly describe the roles, responsibilities, and functions that the student will perform as an Intern in your agency or organization. What types of training, coaching and supervision will the student receive as part of his/her internship? ___________________________________________________________________________ ___________________________________________________________________________ ___________________________________________________________________________ How is the student going to be evaluated by the agency? ___________________________________________________________________________ Signature of Agency Supervisor Date "78GTqr   % a  y )   > ? ޼jhsUmHnHuhMvh4|rjhQbpUjhUmHnHujhUhQbphh h4|r5CJaJhIh 5CJaJ5"8TUpq  ^ _ + ,  hgd4|r hh`hgd hgd hgd$a$gdQbp, y z ( )   g h i    ? gdQbpgd4|r21h:pI/ =!"#$% 6666666662 0@P`p2( 0@P`p 0@P`p 0@P`p 0@P`p 0@P`p 0@P`p8XV~_HmH nH sH tH @`@ NormalCJ_HaJmH sH tH DA D Default Paragraph FontRiR  Table Normal4 l4a (k (No List PK!pO[Content_Types].xmlj0Eжr(΢]yl#!MB;.n̨̽\A1&ҫ QWKvUbOX#&1`RT9<l#$>r `С-;c=1g'}ʅ$I1Ê9cY<;*v7'aE\h>=,*8;*4?±ԉoAߤ>82*<")QHxK |]Zz)ӁMSm@\&>!7;ɱʋ3װ1OC5VD Xa?p S4[NS28;Y[꫙,T1|n;+/ʕj\\,E:! t4.T̡ e1 }; [z^pl@ok0e g@GGHPXNT,مde|*YdT\Y䀰+(T7$ow2缂#G֛ʥ?q NK-/M,WgxFV/FQⷶO&ecx\QLW@H!+{[|{!KAi `cm2iU|Y+ ި [[vxrNE3pmR =Y04,!&0+WC܃@oOS2'Sٮ05$ɤ]pm3Ft GɄ-!y"ӉV . `עv,O.%вKasSƭvMz`3{9+e@eՔLy7W_XtlPK! ѐ'theme/theme/_rels/themeManager.xml.relsM 0wooӺ&݈Э5 6?$Q ,.aic21h:qm@RN;d`o7gK(M&$R(.1r'JЊT8V"AȻHu}|$b{P8g/]QAsم(#L[PK-!pO[Content_Types].xmlPK-!֧6 -_rels/.relsPK-!kytheme/theme/themeManager.xmlPK-!!Z!theme/theme/theme1.xmlPK-! ѐ'( theme/theme/_rels/themeManager.xml.relsPK]# % ,  8@d(  VB  C D"?VB  C D"?VB  C D"?VB  C D"?VB   C D"?VB  C D"?B S  ?p00t0t"<t $P$t\ t!t tV]:::5wb I^`o(. ^`hH. pLp^p`LhH. @ @ ^@ `hH. ^`hH. L^`LhH. ^`hH. ^`hH. PLP^P`LhH.5wb            ESkQbp4|rMvI $L>sB@(@UnknownG*Ax Times New Roman5Symbol3 *Cx ArialA$BCambria Math"ht"Gx"G   !243QHP)? 2!xx ,!University of Wisconsin MilwaukeelkwCarlos Galvao Sobrinho  Oh+'0 (4 X d p|'$University of Wisconsin Milwaukeelkw Normal.dotmCarlos Galvao Sobrinho3Microsoft Macintosh Word@0@2@"2  ՜.+,0( hp  '$University of Wisconsin - Milwaukee  "University of Wisconsin Milwaukee Title  !"$%&'()*-Root Entry Fn072/1Table WordDocument4SummaryInformation(DocumentSummaryInformation8#CompObj` F Microsoft Word 97-2004 DocumentNB6WWord.Document.8