Intern mentor data form

Reynolds School of Journalism

INTERN MENTOR DATA FORM

(to be filled out by the MENTOR)

Name of intern: _______________________________________ Date: ______________

Company:_______________________________________________________________

Name and title of mentor: ___________________________________________________

Address:_______________________________________________________________

______________________________________________________________________

Phone: ______________________ Fax: ________________________

Area of concentration of this internship:

__________ Advertising

__________ Broadcast Journalism

__________ Print Journalism

__________ Public Relations

__________ New Media

Duties of the intern: ______________________________________________________

______________________________________________________________________

Has this company previously had any interns? ___________________________________

Will this be a paid internship? ________________________________________________

If yes, what is the rate of pay? ______________________________________

If no, would you be able to pay the intern's tuition for this course and related expenses?

______________________________________________________

or offer a scholarship to the student? _________________________________

Please call (775) 784-6531 to discuss with administrator Mary Caulk methods for paying an intern's tuition or for providing scholarships. The journalism school requires at least 120 hours of work be completed for each internship credit. Do you have a preference as to how these hours are scheduled? (i.e. number of hours worked per week; number of weeks worked, etc.):

______________________________________________________________________

Please return this form to Internship Coordinator, Reynolds School of Journalism, Mail Stop 310, University of Nevada. Reno, NV 39557-0040.

THANK YOU!