iWorks Interest Form

Name of Organization:

Phone Number:

Address:

We are looking to host iWorks Intern(s):
Fall Term (September 10 – December 9, 2025)Winter Term (January 7 – April 7, 2026)Summer Term (exact dates to come, July – August 2026)

Department/Location where the intern will be working:

Intern's immediate supervisor/ Title/ Contact # and Email Address:

Name & Title:

Telefone #:

E-mail:

Other supervisor Title/ Contact # and Email Address:

Name & Title:

Telefone #:

E-mail:

Number of Interns:

Interns' daily responsibilities:

Expectations, guidelines, and rules (please be as thorough as possible):

ADDITIONAL INFORMATION

Is a CORI/SORI required by your agency?SimNão

Se sim, please provide a copy when you complete this form.

Are Immunizations/physical exam required?SimNão

What is your agency's dress code?

WORK SCHEDULE

Interns are expected to work a minimum of 10 hours per week at the internship placement site over the agreed
upon internship period.

Segunda-feira

Start Time:

End Time:

# of hours:

Terça-feira

Quarta-feira

Quinta-feira

Sexta-feira

Sábado

Domingo

PLACEMENT SUPERVISOR INFORMATION

Placement Supervisor is expected to:

• Work with job coaches to schedule youth interviews.

• Meet with job coaches before the internship begins to get details about your intern. Job coaches will be accessible throughout the program to provide extra support to you and your intern.

• Meet with job coaches every other week to discuss intern's progress and complete feedback evaluations.

• Provide intern(s) with a letter of recommendation at the completion of the internship.

• In order for youth to be paid in a timely manner, please send timesheets every Wednesday by 11am. A timesheet packet will be emailed to you.

I have reviewed the Placement Plan and Agreement and concur with the timeframe, work schedule, and job description.

Placement Supervisor Signature:

Date: