Term Report Receipt
Complete and return this form ONLY if your Term Report will NOT be submitted by the
deadline date. A grade of UNSATISFACTORY will be given when a Term Report or properly
authenticated Term Report Receipt is not received by deadline date.
Name: Email:
Employer Address:
City/State/Zip Code
Supervisor Name and Title:
Work Phone Co-op Plan:
Specific reason for report being submitted late (illness, accident, family emergency, company proc-
essing or other reason beyond student/supervisor’s control):
Date: Signature:
Fax:
Center for Career Development
Box 5021 • Cookeville, TN
38505
Phone (931) 372-3296 • Fax (931) 372-6154
http://www.tntech.edu/career career@tntech.edu
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