RETURN TO CSUN HOMEPAGE
Purchasing & Contract Administration
PURCHASING DEPT.
TEL NO: (818) 677-2301
FAX NO: (818) 677-6544
MAIL DROP: 8231
Community Partner Profile
Request to Initiate an Internship Agreement
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Instructions for Faculty Members:

FORWARD THIS COMPLETED FORM TO PURCHASING & CONTRACT ADMINISTRATION, MAIL CODE 8231, OR FAX TO MARY RUEDA AT (818) 677-6544, TO INITIATE AN INTERNSHIP AGREEMENT.
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I. Type of Organization: NON-PROFIT GOVERNMENT SCHOOL OTHER
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II. Community Partner (CP): STREET ADDRESS: WEBSITE URL:
EXECUTIVE DIRECTOR: CITY: STATE: ZIP + 4:
TELEPHONE: FAX NUMBER: ALT. PHONE: EMAIL ADDRESS:
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III. Community Partner Mission Statement: (optional)
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Faculty Member Requesting Internship Agreement:  

Date:


Name of Student :

 

*IMPORTANT NOTICE*
INFORMATION YOU ENTER ON THIS FORM CANNOT BE SAVED.
YOU MUST PRINT THIS DOCUMENT BEFORE CLOSING THE
WINDOW.