master internship datasheet - UFR Physique et Ingénierie

MASTER INTERNSHIP
DATASHEET
Recto
I. Contact details of the trainee during the internship :
Student number :
Lastname &
first name :
Mention of the Master's degree :
Speciality degree :
Address :
Phone number & email :
Part reserved for the HOST ORGANIZATION
II. Host organization :
Name / Address / Stamp :
III. Internship period : Part-time / Full-time (Cross off the useless mention)
Beginning and end : From
to
Company closed : From
Hours per week :
Presence at night and/or on Weekends :
hours
yes or no
to
Effective hours :
Travel during the intern :
hours
yes or no
IV. Stipend - Benefits - Mandotory information for the edition of the internship contact / agreement
€ net / hour
Amount :
Bank transfer, check or species (Cross off the useless mention)
3,60 € minimum for any exceeding internship 44 actual days in France
Lodging
Benefits : Food
Reimbursement of expenses
Other ……………………………………………………………………………………………………………
V. Signatory of the internship agreement :
Lastname & first name :
Capacity :
VI. Host organization administrative contact :
Lastname :
First name :
Phone number :
email :
VII. Coordinates of the internship supervisor :
Lastname :
First name :
Phone number :
Position :
email :
Part reserved for the UNIVERSITY DEPARTMENT
VIII. Validation du sujet par l'UFR :
Signature :
IX. Enseignant référent :
Nom :
Prénom :
Tél. :
E-mail :
Date : Le :
Signature :
Annexe B
MASTER INTERNSHIP
DATASHEET
Verso
X. Subjects of the internship period :
Place of the internship :
Title of the internship :
Skills to be
acquired/developed :
http://www.physique-ingenierie.unistra.fr/spip.php?article247
Objective of the internship :
Activities assigned :
Expected output :
Tools / methods to be
used for carrying out the
task :
Miscellaneous :
XI. Personal commitment of the internship supervisor :
Signature of the internship supervisor :
Date : The :
Isabelle HUBER
Tél : 03 68 85 49 70
Fax : 03 68 85 06 96
[email protected]
Please complete this paper and return it to :
UFR Physique et Ingénierie
3-5 rue de l'Université
F - 67084 Strasbourg cedex
Annexe B