Business Name

Mailing Address

Phone Number
example: 999-999-9999

What kind of business is it?
Construction
Manufacturing
Retail
Service
Wholesale
Other

Student Name

Please provide the project name for the internship.

Internship Category?
Advanced Manufacturing
Advanced Materials
Bioscience
Controls and Electronics
Information Technology
Instruments
Power and Propulsion

When did the internship start?    

Describe the work performed...

Describe any technical, professional, or leadership skills taught...

Describe how the internship has impacted your organization...

Describe best part about the internship program...

SUCCESS STORY RELEASE AUTHORIZATION

For valuable consideration, I hereby consent to and authorize the use of my business success story for use by the Ohio Business Connection, Ohio Department of Development, the Small Business Development Centers of Ohio and its network affiliates.

I hereby release and discharge the Ohio Business Connection, Ohio Department of Development, the Small Business Development Centers of Ohio and its network affiliates from any and all claims and demands arising out of or in connection with the use of such photograph and article, including any and all claims for libel, the right of publicity and the right to privacy.

By typing your name, title and date into the fields below and clicking on submit, you are indicating you agree with the above statements.

Your Name

Your Title

Today's Date