Student’s Name: ______________________

W.I.S.E. INTERNSHIP SITES

Please list two potential sites, the names of two potential site supervisors, and their phone numbers.

NAME OF SITE PHONE # & ADDRESS CONTACT’S NAME

1. __________________________ __________________________ ____________

__________________________ __________________________

2. __________________________ __________________________ ____________

__________________________ __________________________

3. __________________________ __________________________ ____________

__________________________ __________________________

If you need help, we have site lists. Please let Ms. Witkin or Mr. Evangelista know immediately.

Your mentor is__________________________