International Students and Scholars Office 415 South Street | Kutz Hall 215 | MS 040 | Waltham, MA 02453-9110 781-736-3480 | 781-736-3484 Fax | isso@brandeis.edu | www.brandeis.edu/isso J-1 Student Intern Program Academic Advisor (Home Institution) Recommendation Form To Be Completed by the Student Intern: Name (Last/Family Name, First, Middle): I hereby grant permission for the information provided on this form to be forwarded to Brandeis University Student Intern’s Signature: To Be Completed by the Academic Advisor at the Student’s Home Institution: Advisor’s Name (Last/Family Name, First, Middle): Title: Advisor’s Email Address: Name of Institution: Institution’s Mailing Address: Student Information Degree that the student is currently pursuing at your institution: Student’s estimated degree/certificate completion date at your institution (month/day/year): By signing this letter, I certify the following: • • • This internship will fulfill the educational objectives for the intern’s current degree program at his/her home institution I certify that the student will be earning credit or fulfilling a requirement of their undergraduate degree program I approve this student’s participation in their internship at Brandeis University Advisor’s Signature: _ Date: If the student intern served as a translator/interpreter for the advisor, please sign below confirming that the advisor fully understood the content of this document and the internship opportunity at Brandeis University before signing Student Intern’s Signature _