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 have questions about this form or would like more information about the Summer Funding Programs or the Work Exemption Program, 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 the Summer Funding and Summer Work Exemption Program (WEP), it must be either unpaid or compensated at less than the equivalent of New York State minimum wage (less than $15).

During the academic year, in order for an opportunity to be eligible for the 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.
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