Instructor Request Form

Please allow 10 to 12 weeks for the Memorandum of Understanding (MOU) to be fulfilled.

Contact Us: For additional questions, please e-mail the Education Coordinator at kira.king@jocogov.org or call (913) 477-8337.

General Information

Request Date *

Month

Day

Year

# students for placement (per semester) *

Degree Program *

Course Title *

Instructor *

Office Phone *

E-mail Address *

College Name *

School of *

Internship Requirements

Semester *

Year *

Start Date *

Month

Day

Year

# of weeks *

Total hours required *

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