Internship

723 ; 724

Student name

Student number

Current GPA

Semester of study

Student's faculty advisor

Student's advisor consent

Yes ; No

Faculty supervisor of the project

What are the specific duties of the intern

What are the learning outcomes of this internship

Faculty mentor, how does this internship contribute to the student's graduate career or overall career goals?

Student Signature

Internship mentor Signature

HMSX graduate committee approval

HMSX Director Signature