Bukalasa Agriculture College
Bukalasa
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Student Internship Application Form
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Student Internship Application Form
Bukalasa Agricultural College
P.O Box 174, Wobulenzi
“Agriculture for Health and Wealth”
OFFICE OF THE ACADEMIC REGISTRAR
Student Internship Application Form
PART A: APPLICANT DETAILS
Applicant Name
Name of Institution
Telephone Contact
District
Ngora
Kumi
Email
Study Programme
PART B: INTERNSHIP DETAILS
Proposed Date of Commencement
Duration of Internship
Areas of Interest
Area of Interest 1
Area of Interest 2
Area of Interest 3
Area of Interest 4
PART C: CATERING SERVICES
Indicate Whether you will need catering services :
Yes
No
PART D: APPLICANT DECLARATION
I Understand that (Please tick)
I have to attach the institution letter to this application
I will comply by college regulations/instructions governing this activity
I will be fully responsible for my upkeep including feeding and accommodation throughout the internship period
I have to return this form at least one month before commencement of the internship to allow for proper planning
Any information I get into contact will be used only for the internship
The internship may be terminated if I fail to fulfil agreed upon tasks and where am found to be uncooperative and disobedient
I further declare that all the information provided in this form is correct and I take full responsibility for its use for this activity.
Name of Applicant
Date
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