Student Internship Agreement

Starting the internship process requires two steps:

1. Complete the form below (this starts the evaluation process)
2. Complete the Internship Independent Study Form (this registers your internship for course credit)

Students who wish to complete an internship for credit must agree to the following requirements. If students hope to learn from the internship experience, they should apply themselves fully to the work appointed them by their employers.

Students involved in the internship program must agree to the following:

1. Students should be a second-semester sophomore, or a junior or senior.
2. Students are responsible for registering for the internship.
3. For each hour of credit, the student must spend a total of 60 hours at the internship site.
4. Students agree to pursue the internship for no more than 3 credit hours (per internship).
5. Students must provide the Faculty Internships Coordinator with information about how they can be contacted during the internship.
6. Upon completion of the internship, students must summarize their duties and the work performed in a written report. A digital sample of work should be included for review. Credit will not be granted until this report is submitted.
7. It is the student’s responsibility to make sure the final evaluation by the employer has been completed.

Use the form below to inform the Faculty Internships Coordinator about your internship. This information will only be used for this internship and will not be shared with others or re-used for other purposes. A copy of this form will be sent to the Employer via e-mail.

Once the Internship Independent Study Form is completed, e-mail or print and submit it to the Faculty Internships Coordinator (Kristen Pericleous).

Student Internship Agreement

Student Internship Agreement

Student Name *

First and last name.

Expected Graduation Year 20162017201820192020202120222023

Internship Credit * Fall 2017Spring 2018Fall 2018Spring 2019Fall 2019Spring 2020

Indicate either a fall or spring semester after you complete your internship when you would like to have the class appear on your transcript. Consider how this balances with other courses to ensure you are still a full-time student (if that is a concern). Each students' needs will vary.

Email Address *

The address you will use during the internship.

Phone Number *

The phone number you will use during the internship.

Information About This Internship

Internship Position/Title *

Internship Company or Organization Name *

Internship Company or Organization Address *

Internship Company or Organization Address

Internship Company or Organization Address

Internship Company or Organization Address

City

City

State/Province

State/Province

Zip/Postal

Zip/Postal

Country AfghanistanAland IslandsAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBruneiBulgariaBurkina FasoBurundiCôte d'IvoireCambodiaCameroonCanadaCape VerdeCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos (Keeling) IslandsColombiaComorosCongoCook IslandsCosta RicaCroatiaCubaCuracaoCyprusCzech RepublicDenmarkDjiboutiDominicaDominican RepublicEast TimorEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEthiopiaFalkland Islands (Malvinas)Faroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKosovoKuwaitKyrgyzstanLaosLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacaoMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth KoreaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestinePanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarReunionRomaniaRussiaRwandaSaint BarthelemySaint Helena, Ascension and Tristan da CunhaSaint Kitts and NevisSaint LuciaSaint Martin (French part)Saint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint Maarten (Dutch part)SlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and the South Sandwich IslandsSouth KoreaSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan MayenSwazilandSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTurks and Caicos IslandsTuvaluUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUnited States Minor Outlying IslandsUruguayUzbekistanVanuatuVatican CityVenezuelaVietnamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabwe

Country

Name of Main Contact/Supervisor *

Main Contact/Supervisor Title *

Main Contact/Supervisor Email Address *

Internship Start Date *

Internship End Date *

If you are unsure of the exact end date, select a date to the best of your knowledge.

Agreement

I agree to complete and abide by the student internship responsibilities. *

Yes. I agree.

Checking this box and submitting this form signifies your agreement to carry out the responsibilities of this internship.

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