CCE Funding Programs / WEP Employer Verification Form

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 cce-funding@columbia.edu or visit our website.

Intern’s Information

Intern's First Name *

Intern's Last Name *

Intern's UNI *

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

Intern's Columbia University Email Address *

ex. abc123@columbia.edu

Employer Information

Name of Organization *

Supervisor's Title *

Supervisor's First Name *

Supervisor's Last Name *

Supervisor's Email *

Supervisor's Phone Number *

Supervisor's Address

Street Address 1 *

Street Address 2

City *

State / Province *

Postal / Zip Code *

Country *

Position Information

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

Work will begin on: *

Year

Month

Day

Work will end on: *

Year

Month

Day

Please indicate how many hours per week the intern will work: * hours

Please indicate the total number of weeks the intern will work: * weeks

Please indicate the total number of hours the intern will work: * hours

Is this student continuing a research position, internship or volunteer opportunity with you from the previous semester? *

If yes, please provide brief feedback on this student’s performance and progressive responsibilities. *

Does this opportunity offer a stipend or other form of compensation? *

If yes, please indicate the type of compensation such as salary, stipend, hourly wage, room and board, etc. *

Amount of Compensation * $

*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.

Signature *

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 http://www.dol.gov/whd/regs/compliance/whdfs71.htm).

I hereby certify that the following intern has been selected to undertake work with this organization and that this will be an unpaid experience: *

Please Initial.

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