internship application form usth 2017

internship application form usth 2017 tài liệu, giáo án, bài giảng , luận văn, luận án, đồ án, bài tập lớn về tất cả các...

University of Science and Technology of Hanoi

INTERNSHIP PROGRAM APPLICATION FORM STUDENT’S INFORMATION

(DD/MM/YYYY) First name Last name Date of Birth

Origin of birth Present nationality Other nationalities (if any)

Passport Number Place of issue Date of Expiry

( ) - ( ) - ( ) -

Local Telephone Number Work Telephone Number Cell Phone Number

_

Class Standing Expected Graduation Date Cumulative GPA Semester & Year

( ) - Emergency Contact Name Relationship Telephone Number

HOME INSTITUTION INFORMATION

Internship Supervisor Title

( ) -

Academic Advisor (if different from above) Title ( ) -

E-mail Address Telephone USTH’S SPONSORING DEPARTMENT INFORMATION Sponsoring Organization: Hanoi University of Science and Technology of Hanoi Division/Department: Head of Division/Department:

Have you contacted internship supervisor of USTH? Yes  No Internship Supervisor: Supervisor’s Title:

Location of Job:

Summary of Job:

STUDENT’S INTERNSHIP PLAN Start Date: End Date:

Month Day Year Month Day Year Work Schedule: Hours Per Week Expected:

Supervisor/Student Contact Hours:

Financial plan for internship  Self-support Home institution/supervisor

 Other sources (please specify): Type of internship program:  Paid  VND Per ( Hr/ Wk/ Mo)  Unpaid  Credit  Number of credit  Non-credit Request support from USTH’s Division/ Department:  Finding room & board  Stipend  Scholarship

 VISA  Others (please specify) On-site Activities/Responsibilities: _

Physical Demands/Work Environment:

Equipment/Machinery to be used:

Other:

STUDENT’S INTERNSHIP OBJECTIVES AND CONTENTS Time Content Signature of student and home institution supervisor:

Student Date

Supervisor Date

Academic Advisor (if any) Date Approval of sponsoring department and supervisor:

Sponsoring supervisor Date

Head of division/ department Date

International Officer Date