Student Internship
REPORT BY STUDENT
*indicates mandatory fields
INSTRUCTIONS
1.
This form is to be completed on a progressive basis as you move through your Internship.
2.
At the end of your Internship, the completed form should be emailed to [email protected].
3.
All information provided on this form will be treated confidentially.
Courtesy Title*
First Name*
Last Name*
Student ID*
Please select
Telephone No *
Email*
Please list your mentors and any supervisors involved in your internship*
NAME
AFFILIATION
CSU
NSW DPI
OTHER
CSU
NSW DPI
OTHER
CSU
NSW DPI
OTHER
CSU
NSW DPI
OTHER
CSU
NSW DPI
OTHER
CSU
NSW DPI
OTHER
CSU
NSW DPI
OTHER
CSU
NSW DPI
OTHER
CSU
NSW DPI
OTHER
CSU
NSW DPI
OTHER
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Please describe the activities you have undertaken for each section, location or project you have
been involved in during your internship and did they relate to your intended goals? *(If more space is
required, please attach a separate list).
SECTION/LOCATION/PROJECT
ACTIVITIES UNDERTAKEN
Describe how your experience was of benifit to your career development?
(For example: Did you encounter any problems or difficulties along the way? What were the
highlights/lowlights?) (max 550 characters- approx 80 words)
Please provide any suggestions you might have for ways in which the Internship Scheme
could be improved or enhanced? (max 550 characters- approx 80 words)
Please provide any other relevant information (max 280 characters- approx 50 words)
Save Form
Submit Form
Clear Form
If you have any difficulty in submitting your application, please use the ‘Save As’ button, save the file to your computer
and then send as an email attachment to [email protected]
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