Internship Tracking Form

***This form is for internships that are NOT earning academic credit. If you wish to pursue academic credit for your internship, please review the application process.

STUDENT INFORMATION

Name

First
Last

Banner ID (9 digits)

Xavier Email Address

COMPANY/ORGANIZATION INFORMATION

Company/Organization Name

Supervisor's Salutation

Supervisor's Name

First
Last

Supervisor's Title

Supervisor's Email Address

Supervisor's Phone Number

(###)
###
####
Extension

Address

Street Line 1

City
State

Zip/Postal code

INTERNSHIP INFORMATION

Start Date

End Date

Job Title/Position

# Hours/Week

Hourly Pay Rate $

How did you find the internship?

If "other", please specify

Did you meet with a WCB staff member/career coach regarding your internship search?

If yes, did you find their advice/information helpful?

Additional questions may be directed to Sarah Brinker-Good, Coordinator for the Executive Mentor and Internship Programs. You may also visit www.xavier.edu/williams/internships for more information.