Field Visit Form
Student Name: __________________
Project ID: __________________
Mentor Name: __________________
Intern ID: ___
Date of the Visit: ________
Suggested/Referred By: _________________________________
Visit No.: ____
If more Trips required to the same organization: Yes/No
Goal of the visit:
1. ______________________________________________________
2. ______________________________________________________
3. ______________________________________________________
Goals Met:
1. ______________________________________________________
2. ______________________________________________________
3. ______________________________________________________
Persons Met(*)
1. Name: _________________________________________
Duration and Timings of Discussion: _______________________
Details of the Discussion: ______________________________________________________
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2. Name: _________________________________________
Duration and Timings of Discussion: _______________________
Details of the Discussion: ______________________________________________________
___________________________________________________________________________
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3. Name: _________________________________________
Duration and Timings of Discussion: _______________________
Details of the Discussion: ______________________________________________________
___________________________________________________________________________
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*Add more as needed by attaching more pages in same format