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op Faculty Site Visit Report Form

Cooperative Education and Internship Program (CEIP)   College of Engineering 

Faculty Site Visit Report Form

Please complete this form. Thank you!

Fill out the information requested below and, when done, click the "Submit Form" button. Use the tab key to move between fields. Note that the Enter Key will submit the form before it is completed.

Items marked * are required fields!

Site Visitor's Information   
Site Visitor's Last Name      *    
Site Visitor's First/Middle Name      *   (First Middle)    
  *   
Student Information   
Student Last Name      *    
Student First/Middle Name      *   (First Middle)    
Student Identification Number      *   (NOT SSN)    
Date of visit   
   
(Click the calendar icon to select date)    
Discipline       
Work Term   
 1    2    3    4    5
   
Job Information   
  *   
Supervisor's Last Name      *    
Supervisor's First/Middle Name      *   (First Middle)    
Phone      (###-###-####)   
Reports   
   
   
   
   
   
Is the student expected to return?   
 Yes  No
   
If yes   
 Fall  Spring  Summer
Year: 20    
   
   
   
   

Site Visitor's Signature      (Please Initial Here)   *    
Security Image:    * Security Image Audio Icon Refresh Icon    
   

Contact Info:

Email Site Comments

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