Dear Employer,

Please complete the form below to verify the work that your intern will do with your organization this semester/summer.

This form must be completed by the individual who will be directly supervising your intern. Supervisors must be a professional staff member of the organization, fellow students may not complete this form. The funding program committees will reach out to you mid-semester/mid-summer to verify that your intern is fulfilling their work commitment.

If you would like more information about the CCE Funding Programs or have questions about this form, please email or visit our website. 

Intern’s Information


(ex. abc123 – your intern will need to provide their UNI to you)

Employer Information


Supervisor's Address

Position Information

Please provide position information only for the semester for which the intern is applying 


*Note that in order for an opportunity to be eligible for CCE Summer Funding and Work Exemption Program (WEP) funding in the summer, it may be either unpaid or compensated at less than the equivalent of New York State minimum wage, and still remain eligible for funding.

During the academic year, in order for an opportunity to be eligible Work Exemption Program (WEP), it must be unpaid.

By providing my electronic signature, I verify that this unpaid or low-paid opportunity is consistent with the requirements of the Fair Labor Standards Act (FSLA) and applicable state and local law. (Additional information about the FSLA can be found at
Please Initial.
This question is for testing whether or not you are a human visitor and to prevent automated spam submissions.