Canisius College - Internship Information Form

Please complete this form prior to beginning your COM, DMA or JRN internship.

Name
Local Address
Local City
Local State
Local Zip
Local Phone
Email
Would you like business cards?: Yes No

Supervisor Name
Title
Name of organization
Address
City
State
Zip Code
Phone Number
Supervisor Email
Please indicate if this internship is for COM, DMA or JRN: COM DMA JRN
Number of credits: 3 6 9 12