1.	Today's Date*
	mm/dd/yyyy

2.	Name*

3.	Major*

4.	My phone number is*

5.	My email address is*

6.	I have accepted an internship/co-op at*

7.	Employer Address

8.	My supervisor is

9.	My supervisor's phone number is

10.	My supervisor's email address is

11.	Start Date
	mm/dd/yyyy

12.	Pay Rate

13.	Hours per week

14.	Comments