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Internship Activity Report

(To be completed by the student intern)



Student Intern's Name:
Please enter your address, phone number, and other contact
information while on this internship:
Please enter today's date:
Report number:
Communication with supervisor:
Physical well being (food, lodging, general health):

Opportunity to learn and practice skills:
Your level of satisfaction with this experience so far:

Assumed level of satisfaction of the experience provider:

Cooperation with fellow workers:
Please rate your work speed:
Please tell me your level of ability to handle responsibility:
How are you handling suggestions from supervisors?
What level of technical competence have you achieved?
In the following boxes, please list jobs or duties you have been performing. Indicate how many hours you have spent on each job, and what level of proficiency you have achieved:
Additional  job or duty:
Additional job or duty:
Additional job or duty:
Any comments or thoughts you would like to share:
Are you keeping a daily journal of your experiences?


Please enter the number of hours worked during this report period:


Please enter the total number of hours worked so far on this internship

Please indicate number of hours/days absent from duty, and explain reason for absence.  Please remember to clear any absence with your supervisor, and the department coordinator.
Firm name and address:
Owner/Supervisor name:
Phone number:
Your preferred email address (not the employers):


If it does not submit, please print or save this form and send it to: Ben Romney, BYU Idaho, 525 S Center St. 1120 Rexburg ID 83460 OR remneyb@byui.edu OR fax to (208) 496-6017




Applied Plant Science Department

Rexburg, ID 83460-1120

(208) 496-4581