STUDENT INTERNSHIP PROGRAM
 WORKSITE CONFIRMATION NOTICE 
This notice confirms the student internship program placement of one of our students in your business/industry as
indicated below. Thank you for participating in this career development opportunity.
Student Internship Worksite
Student’s Name
Social Security Number
Student’s School
Student’s Grade Level/Age
Student’s Phone
Student’s Career Interest
Student Internship Dates (Begin/End)
Worksite Contact Person’s Name
Phone
School-To-Work Coordinator’s Name
Phone
Adopted from the Catawba Technology Education Consortium, Catawba County, North Carolina