| INTERNSHIP CONTRACT
Student Name
Student ID
Course Number
Mailing Address During Internship
Email Address (list all)
Faculty Supervisor
Grade Type
Worksite Supervisor Name, Title
Worksite Name and Address
Work Phone
(letter grade or credit)
Beginning Date
Credits
(50 work hours/credits)
Total Hours
Class Year
(Soph., Junior, Senior)
Semester
(spring, fall, summer)
(please include zip code)
Ending Date
Approval of Dean
Date
Note to students and instructors: All information and signatures must be provided before this form will be accepted. This form constitutes a learning contract but does no confer registration in the course. Internship courses are subject to the same academic regulations as those governing other courses, including course registration on the Personal Data Questionnaire (PDQ), summer registration form or by “Add� slip before the end of the add deadline-ordinarily the first two weeks of the semester.
The Academic Dean or a designee must approve all Internship Contracts 1. Learning Objectives a. b. c. d.
2. Activities Meet with faculty instructor as follows:
Hours per week at worksite:
Job description (can be attached is insuffcient room):
3. Student’s Responsibilities: All students shall be responsible for the Initial Report, Biweekly Reports, Self Evaluation and Final Reports Other Responsibilities, if applicable:
4. Evaluation Criteria: Student’s grade will be based on work site supervisor’s evaluation of overall performance and the faculty instructor’s evaluation of the reports. Other Criteria:
Student’s Signature
Date
Faculty Instructor’s Signature
Date
Faculty Advisor’s Signature
Date
Department Chairpersons Signature
Date
(agreement to above conditions)
(Course is relevant to students academic course study)
(agreement to above conditions)
(Course of instruction is acceptable)