Internship Manual
and
Forms Packet
2019-2020
PREFACE
Western Nebraska Community College (WNCC) recognizes that there are
important elements of career preparation which cannot adequately be taught within
the confines of the classrooms of the college. WNCC offers credit-bearing
internship opportunities through many of its degrees and certificate programs. The
goal of the internship is to provide students with the necessary real-life, on-the-job
employment experiences to help prepare them for a future in their chosen career.
The WNCC Internship Manual and Forms Packet is provided to assist students,
faculty, and employers who will be participating in the internship program to
understand the requirements and considerations of internship for credit at WNCC.
Although individual departments may need to adapt certain material to meet
specific program needs, agreements and evaluation forms are consistent across
departments, so that students’ outcomes are consistent.
It is our hope that each student’s internship experience is rewarding and
worthwhile for all involved. Ongoing evaluation of the internship program will be
important. Please feel free to contact us with any questions you may have.
Tonya Hergenrader Amy Zitterkopf
Career Pathways & Advising Director Career Pathways Advisor
(308) 635-6346 (308) 635-6336
OVERVIEW OF WNCC INTERNSHIPS
Frequently Asked Questions
What is an internship?
It is work-based learning that ties academic education to the workplace. Students
participate in relatively short-term work placements, paid or unpaid. An internship
may or may not be tied to academic credit at WNCC. Internships that are tied to
academic credit are guided by learning objectives and evaluated by both the
employer and a WNCC faculty sponsor. WNCC does not require a formal
evaluation for internships that are not tied to academic credit, and these
experiences will not show up on students’ transcripts.
What is the difference between an internship and a practicum?
A practicum requires an in-class component of learning and is always tied to
academic credit at WNCC. Practicums are not paid learning experiences.
Internships, as stated above, can be paid or unpaid, and may or may not be tied
to credit. Also, internships do not require any in-class learning experiences, but
may require prior in-class learning experiences.
What is an internship for academic credit?
WNCC offers internship courses that are tied to various programs of study. For
example, ENGR 2500 - Engineering Internship, is the course that is tied to the
Engineering program. Internship credit hours will be determined by the student,
employer and faculty sponsor based on the terms of the contract. Each credit hour
requires the completion of a minimum sixty (60) hours of on-the-job participation
within a semester (summer, fall or spring). Maximum credit hours earned for each
internship course is three (3) or one hundred-eighty (180) hours. It is possible for
students to take more than one internship course in one semester. Internship
courses may be repeated, meaning that students can complete more than one
internship for credit during their time at WNCC, but the maximum number of credits
that can be earned for internships is twelve (12).
How does internship credit apply to a degree program?
For some programs of study, internship courses are required in order to graduate.
For others, internship credits are optional and are tied into the curriculum as a
choice, but will count toward core program completion for graduation. For
programs of study that do not tie internships into requirements for graduation, but
offer internship courses, the courses will count as elective credit only.
How are learning objectives and outcomes established for internship
courses?
Learning outcomes are set forth in the internship course syllabi, and are created
by the faculty sponsor. These broad outcomes describe the expected discipline-
specific result(s) of the internship experience for the student. Learning objectives
are created by the student and employer together to define and target worksite-
specific learning activities that promote achievement of the overall learning
outcomes.
Guidelines
Assessment: To effectively assess students’ internship experiences at WNCC,
the following requirements are to be completed and evaluated by the respective
faculty sponsors by the last day of finals week of each semester:
Employer validation of the number of internship hours completed by the
student, which will be documented on the Internship Timesheet and Daily Log
form;
Faculty evaluation of student learning outcomes that are set forth in the course
syllabus for the respective internship (faculty evaluation and assessment may
vary by program);
Employer evaluation of the intern’s performance during the internship which
will be documented on the Intern Evaluation Form. Each evaluation form will
be tied to learning objectives that are set forth in the Internship agreement for
the respective internship.
B
eyond these minimum requirements, assessment of internship experiences is
left to the discretion of the faculty sponsors and may include additional
assignments
or projects.
Financial Considerations: Students must pay tuition and any placement-
related expenses and/or requirements for credit internships based on the
semester hours attempted. Financial Aid may be applied in the same manner
as credit hours for traditional courses, as long as the student has eligibility for
financial aid.
Students should be prepared to pay for any costs associated with the
internship such as travel, meals, tools and/or uniforms and childcare.
Insurance Coverage: Western Nebraska Community College does not
provide students with insurance coverage for their internship. Students are
responsible for providing sufficient health, accident, disability and
hospitalization insurance to cover themselves during the internship. It is
the student’s responsibility to determine whether any insurance is available
through the employer or is otherwise required and all students are responsible
for ascertaining whether their program site provides Workers Compensation
coverage for the student.
If students utilize a personal vehicle during their internship, WNCC provides no
insurance for students to operate a personal motor vehicle and also has no
liability for injury or property damage which may result from that use. Students
must rely solely on their personal vehicle insurance coverage and on any
insurance coverage provided by the participating employer.
Risk of Participation: WNCC itself does not control the way in which
internship sites are structured or operate. In granting credit for this internship
experience, the College affirms that,
to the best of its knowledge, the experience
is an appropriate curricular option for students in WNCC’s program of study and
worthy of college credit; however, it makes no other assurances, express or
implied, about specific arrangements made by students and an internship site
nor any travel and living arrangements the student has made. Students are
strongly encouraged to make an on-site visit to any internship site under
consideration before finalizing their internship agreement.
WNCC does not knowingly approve program opportunities which pose undue
risks to their participants. However, any program or travel carries with it
potential hazards which are beyond the control of the College, its Board of
Governors, officers, agents or employees. As part of this internship program,
each participant will be presented with an Internship Waiver & Release of
Liability form outlining potential dangers and risks.
Considerations for International Students: International students can only
work in the
U.S. after receiving authorization and with certain restrictions.
International students may still need to seek authorization even if an internship is
unpaid. It is the student’s responsibility to know the rules and regulations of their
status to avoid any loss of legal immigration status.
According to U.S. Immigration regulations, 8 Code of Federal Regulations
214.1(e): “A nonimmigrant who is permitted to engage in employment may engage
only in such employment as has been authorized. Any unauthorized employment
by a nonimmigrant constitutes a failure to maintain status…”
In general, international students on a Student Visa are only allowed to participate
in internships that are tied to academic credit and are directly related to their
programs of study. It is very important that international students plan their
internship experiences well in advance, as an intentional component of their
degree programs. Also, as set forth in the Student Visa eligibility requirements,
international students must not work more than 20 hours/week total, which
includes paid internships and other student employment. For example, if an
international student is working 10 hours/week at Bishop Dining Hall, he or she
may not work more than 10 additional hours/week at an internship site.
Anyone who anticipates working with an international student for an internship
should complete the International Student Intern Consideration Form and submit
to the Registrar’s Office.
Course Objectives: A syllabus and internship agreement packet that
include course content, specific outcomes and evaluation procedures must be
agreed
to by the internship faculty sponsor and the student prior to the start of
the internship. Employers will agree to support course outcomes and to
complete an Internship Timesheet and Daily Log and Intern Evaluation Form at
the end of the internship. Please note that course objectives are not the same as
required internship learning objectives.
INTERNSHIP REQUIREMENTS
Student Intern:
1. Student must have completed a minimum of twelve (12) credits in program-
specific coursework that is related to the internship as determined by t
he
department and Faculty Sponsor. For example, a student completing an
internship in biology must have completed a minimum of 12 credits related to
biology. Note: individual academic departments may set forth more rigorous
requirements.
2. Students must have a minimum 2.5 cumulative GPA in program-specific
coursework to be eligible to register for credit-bearing internship. Students
with a program-specific GPA lower than 2.5 must obtain special approval
to register for an internship course from both a faculty sponsor and the
Career Pathways & Advising (CP&A) Internship Coordinator.
3. Students will meet with their faculty advisor or a faculty sponsor first to:
Discuss the possibility of an internship and seek faculty approval to
enroll in an internship course
Obtain and complete the Internship Application
Discuss learning objectives associated with the internship
Learn about academic requirements associated with the course
Set expectations for communication between student, faculty
sponsor and employer
The faculty sponsor for the internship must teach for the department in
which the internship course is offered, and must agree to sponsor the
student internship experience.
4. Students will meet with the CP&A Internship Coordinator second (either
individually
or as a class for required internships) to go over the following:
Resume & cover letter (if appropriate)
Appropriate work attire
Appropriate work communication and time management
Interview skills
Internship expectations and timelines
Thank yous, follow-ups, and general etiquette
Complete appropriate paperwork (which will require faculty
signature) to enroll in course for internship.
5. The third step will be for students will contact the employer associated with the
desired internship sit
e to complete any necessary application materials, conduct
an interview, and tour the site. If selected for the internship, students must
ensure
that all qualifications required by the company are met prior to internship start
date. Students must also complete the following:
All required paperwork by Western Nebraska Community College
(WNCC) and the employer, including but not limited to Internship
Application, Internship Waiver and Release of Liability form, Internship
Agreement, and Intern Feedback Form. This paperwork can be
completed electronically via College Central Network (CCN) - https://
www.collegecentral.com/wncc.
Inform employer of any health conditions that may impact the work
required.
Schedule internship hours to meet the employer’s needs as well as
WNCC’s requirements for credit if participating in the internship for credit
program.
Work collaboratively with internship faculty and the employer to
identify learning objectives, strategies, and learning outcomes relating
the internship activities to academic studies.
6. Throughout the internship experience, students must:
Complete and retain weekly time and activity logs for submission to
internship faculty as required.
Work toward fulfillment of learning objectives, complete any
assignments, and complete number of required internship hours.
Approach responsibilities with dedication, enthusiasm, and maturity.
Represent WNCC positively and responsibly.
Be aware of and comply with both WNCC Student Code of Conduct and
related policies and procedures as well as internship organization
policies and procedures. Always bear in mind that WNCC is being
represented through the intern. Complete Intern Feedback Form at the
conclusion of the internship.
Career Pathways & Advising Internship Coordinator :
1. Sc
reen applications, waivers, and all initial forms required to be submitted by
student.
2. Assist student with submission of forms online (CCN) and route to
appropriate individuals for electronic approval.
Internship Faculty Sponsor:
1. Determine student eligibility for internship and assist with determination of
internship site and relevancy of internship to student program of study.
2. Provide student with the Internship Application form and assist with
completion of the form.
3. Refer s
tudent to Career Pathways for next steps.
4. Determine eligibility for WNCC internship course and appropriate number
of credit hours.
5. Complete all required paperwork by WNCC and the employer. This
paperwork can be completed electronically via College Central Network
(CCN) - https://www.collegecentral.com/wncc.
6. Work with student and employer to identify specific learning objectives,
strategies, and learning outcomes relating the internship activities to
academic studies.
7. Maintain contact with student, employer, and work-site supervisor.
8. Monitor student activities and progress through regular meetings, which
may include on-site v
isits.
9. Address any questions or concerns of the student and work-site
supervisor.
10. Review Intern Timesheet and Daily Logs.
11. Review Intern Evaluation Form, Intern Feedback Form, and any other
required project materials.
12. Determine and assign final grade.
13. Assemble final packet containing daily/weekly time sheets,
evaluation/feedback forms and all required student work. Send this to CP&A
for retention of records.
3. Assist student with the following:
Resume & cover letter (if appropriate)
Appropriate work attire
A
ppropriate work communication and time
management
Interview skills
Internship expectations and timelines
Thank yous, follow-ups, and general etiquette
4. Retain all required internship documentation within the Career Pathways &
Advising Center.
5. Assist faculty sponsors with internship coordination as necessary.
Employer and Work-site Supervisor:
1. Provide training to the intern regardless of race, color, religion, national
origin,
sex or gender, sexual orientation, age, disability, marital status, or
military veteran status.
2. Assign a work-site supervisor who has the time and ability to assist with
intern supervision, training, mentoring, and evaluation.
3. Maintain communication with WNCC faculty sponsor and work-site
supervisor throughout the duration of the internship experience.
4. Assist the student and internship faculty in identifying specific learning
objectives, and strategies relating the internship activities to academic
studies.
Two (2) learning objectives are required for each academic credit
associated with the internship.
5. Provide the student with the appropriate orientation and training for the
internship setting and projects.
6. Provide meaningful assignments and projects, within the constraints of the
student’s time and abilities, to enhance and complement the student’s
academic program goals.
7. Address any questions or concerns of the student and/or the internship
faculty as they arise.
8. Evaluate the student’s internship performance by completing the Intern
Evaluation Form. Discuss the evaluation with the student.
9. Notify WNCC and the internship faculty of any personnel actions which may
affect the student’s standing in the internship.
EMPLOYER GUIDELINES
On-Site Orientation
It is recommended that all employers conduct an on-site orientation. This is an
opportunity to provide information and instruction to the student(s). It is important
that students become familiar with your organization and staff, understand their
responsibilities, learn about organization policies, and attend any necessary
training. The more information that you can cover during the on-site orientation,
the more prepared student(s) will be to work at your organization. Please
encourage students to ask questions and give them feedback about appropriate
behavior at your organization.
The following are some suggestions for what you may want to include in your on-
site orientation:
1) Organization Information: Educate the student(s) about your
organization: Whom do you serve? What are the demographics? How are you
funded? What is your mission? What is your philosophy? What is your history?
2) Staff: Who are some of the staff, and what are their positions and
responsibilities? Are there any technical terms or language generally used by staff
that would be helpful to student(s) to know?
3) Provide a List of Contacts/Numbers: List people/agencies that will be
useful for student(s) in doing their internship.
4) Responsibilities: What is expected of the student(s)? Describe the role
student(s) will play in your organization. How will their performance be evaluated?
5) Policies: Sign-in/out, dress code, office rules.
6) Training: If training is needed, what kind and when?
7) Scheduling: What are your organization’s hours of operation? What hours
are the student(s) expected to be there? When should student(s) complete their
internship? When will you meet with student(s) during the semester to review
work they have done independently?
8) Supervision: It is important that all internship students have a contact
person at the site who will supervise them. The amount of time each student will
need supervision will depend on the project or internship activity. Students may be
allowed to work independently without specific activities assigned each visit. When
structured this way, supervision time can be more effectively utilized for questions
and feedback. If the assigned work-site supervisor will not be available for any
reason, please make certain that the student has another site representative
available if needed.
It is important to remember that students are not volunteers. Students are here to
meet internship requirements and enhance their learning of college course
material and the workplace. Students are receiving academic credit for learning
through their internship efforts. Your assistance in helping interns think about what
their experience means to them and how it relates to their coursework is very
valuable. Additionally, it is important that interns are assigned meaningful tasks
that relate to their learning experience as opposed to menial tasks or “busy work”.
9) Sign-In Procedure: Students are required to have a sign-in time log
completed every time they come to your organization. We ask students to have
their work-site supervisor or someone from your organization sign their weekly
timesheet and daily log at the end of each work week, or more frequently at the
faculty sponsor’s discretion. The student will use one Intern Timesheet and Daily
Log form for each week they work at the internship organization. The Intern
Timesheet and Daily Log forms will then be submitted according to the
requirements set forth by individual faculty sponsor. (The student is responsible
for retaining this documentation)
10) Identification: Provide students with identification from your organization
or require students to have their WNCC identification available.
NOTE: International students on a student Visa require special consideration regarding paid
hours worked and documentation for said work. WNCC Registrar’s Office will provide
guidance on a case by case basis.
INTERNSHIP APPLICATION
Student Information
Complete all requested information. Please print.
This application applies to the following academic session (indicate year in space provided):
FALL ___________ SPRING___________ SUMMER __________
Your Name: Date:
WNCC ID: Email:_____________________________________
Program-Spec
ific GPA: _______________________
* Note: if you need help calculating your GPA for program-specific coursework, contact the Career
Pathways & Advising Office at 308-635-6050.
Home phone: ___________________________
Cell phone:
Local Address: _________________________________________________________________
Street address
City S
tate Zip code
Perm. Address: ___________________________________________________________________
Street address City State Zip code
Are you an international student (check one)? YES NO
Please use this space to explain how this internship will relate to your academic and career goals:
Internship Site Information (if
known)
Internship Site Preference: ________________________________________________________
Contact Person: ________________________________________ Title: ____________________
Contact Phone:________________________________ FAX: _____________________________
Email: __________________________________________________________________________
Address: _______________________________________________________________________
Street address
City
State Zip Code
Anticipated hours per week:
Anticipated total hours for period of internship:
Give a brief description of anticipated type of work/responsibilities:
Is the internship paid (circle one)? YES NO
Student Signature Date
FOR WNCC STAFF & FACULTY USE ONLY
Approve
Pending
Disapprove
Reason for Disapproval:
________________________________________________________
Internship Faculty Signature
_________________
Date
___________________________________________________
Career Pathways & Advising Internship Coordinator Signature
_________________
Date
INTERNSHIP WAIVER & RELEASE OF LIABILITY
NOTICE: This release form is a contract with legal consequences. Please read it carefully before signing.
Student Name (Last, First, MI): ___________________________________ WNCC ID ________________________
Period of Internship: Semester: _________________ Academic Year: ____________________________
Internship Course: _____________________________________ Internship Site ________________________
In consideration for being allowed to participate in an internship as part of my academic pro
gram, I hereby acknowledge
and agree as follows:
1.
I understand that the Western Community College Area, doing business as Western Nebraska Community College
and WNCC (hereinafter collectively “WNCC”) does not require me to participate in the internship and I have
voluntarily chosen to participate.
2. I understand and acknowledge that there are significant risks to which I may be exposed by participating in this
internship, including but not limited to, risks arising from:
Commuting to and from the internship site, or while in the course of internship activities;
Activities indoors and/or outdoors and working with equipment at the internship site;
Acting in an unsupervised capacity while participating in the internship and the internship involves hazards that
are unknown and/or unseen.
3. I knowingly and voluntarily assume the risk that unexpected events may occur and result in harm, injury, or even
death to me while I am participating in internship work or activities or in connection with transportation to and from
the destinations or any associated food or lodging. I hereby and forever release, waive and discharge for myself, my
heirs, executors, administrators, legal representatives, assigns, and successors in interest, any and all claims,
demands, actions or right of action, of whatever kind or nature, either in law or equity, which I may have or accrue
against WNCC, its Board of Governors, administrators, officials, agents, officers, employees, and the suppliers of
equipment, materials and services (collectively known as WNCC), as well as those individuals, governments, and/or
business entities working with WNCC in the internship programs, (collectively known as placements), for any and all
damages which may be sustained by me directly or indirectly in connection with, or arising out of, my participation
or association with the class, internship, or travel related to any of the aforementioned activities or events.
4. I release WNCC from liability for any and all claims of negligence I may have or assert against them individually or
collectively, with the exception of gross negligence or willful and wanton misconduct. I understand that I am
responsible for any medical charges relating to any injury received, as a result of this activity, and it is strongly
recommended that I have adequate health and accident insurance coverage prior to starting this internship.
5. I have read and fully understand that this waiver and release of liability is intended to be as broad and inclusive as
permitted by the laws of the State of Nebraska and agree that if any part is held invalid, the remaining parts of this
waiver and release will continue in full force and effect as intended. I further agree the venue for any legal proceeding
shall be in the State of Nebraska.
___________________________________
________________
Student Signature
Date
PARENT OR GUARDIAN OF A MINOR:
I, as parent or guardian of the below named minor, a person under the age of 19 years, hereby give my permission for my child or
ward to participate in this internship and further agree, individually and on behalf of my child or ward, to the terms of the above
contract for waiver of legal rights.
________________
Date
____________________________________________
Parent or Guardian Signature (if student is under 19)
EMERGENCY NOTIFICATION
Relationship: __________________________
Work Phone: ___________________
BE IT KNOWN THAT, if neither my emergency contacts nor my physician is available at the above contact numbers, I, the
undersigned student, do hereby give and grant consent to the provision of emergency medical treatment to the extent that treatment
is necessary in the medical opinion of the doctor rendering the treatment.
________________________________________________________________________
Student Signature
____________________________
Date
_______________________________________________________________________
Witnessed by:
____________________________
Date
_______________________________________________________________________
Parent or Guardian Signature (if student is under 19)
____________________________
Date
Emergency Contact Name: _____________________________________
Home Phone: __________________________
Cell Phone: _____________________
_______________________________________________________________________________________________________
Address
________________________________________________________________________________________________________
City, State, Zip
S
econdary Emergency Contact Name: ________________________________
Relationship: _________________________
Work Phone: ___________________
Home Phone: __________________________
Cell Phone: _____________________
_______________________________________________________________________________________________________
Address
____
____________________________________________________________________________________________________
City, State, Zip
INTERN TIMESHEET AND DAILY LOG
Keep a daily record of your hours and major activities. You and your work-site supervisor must sign this form each week,
at a minimum, to verify your hours worked. All timesheet/logs must be submitted to the Faculty Sponsor at the end of
every month. Use one sheet for each week.
Intern: ________________________________ Site: ________________
Work-site Supervisor: ___________________
Week of: From ____ / ____ / _____ To ____ / ____ / _____
Date
Time
In
Time
out
Time
in
Time
out
Daily
hours
Total hours for week:
Intern Signature:_________________________________________________ Date: __________________________
Work-site Supervisor Signature:____________________________________ Date: __________________________
Major Activities
Initial/Signature
INTERN EVALUATION
Intern’s Name:____________________________________________________ Date: _____________________
Work
-site Supervisor: _____________________________________ Title: ______________________________
Company/Organization: _______________________________________________________________________
Work-site Supervisor Contact Phone: ____________________ Email: __________________________________
Internship Faculty: __________________________________ Department: ______________________________
Dates of internship: From (mm/dd/yy) ____________________ To (mm/dd/yy) _______________________
Please evaluate the intern’s performance in the following areas:
Exceeds
Expectations
Meets
Expectations
Below
Expectations
Not Applicable
a. Willingness to learn
b. Professional Attitude
c. Knowledge of Subject
d. Dependability and Responsibility
e. Productivity
f. Ability to Communicate Effectively
g. Conformance to Organizational Policies
and Procedures
h. Initiative
i. Organization and Completing Tasks
j. Cooperation with Co-workers and
Supervisors
k. Punctuality
l. Resourcefulness and Ability to Problem
Solve Independently
1. Overall performance of student intern (circle one):
Unsatisfactory Fair
Average
Above Average
Excellent
2. Extent to which student met or exceeded learning objectives associated with internship (circle one):
Above Average Excellent
If you rate the student below average on #2, please explain below:
3. If
you were to write a job recommendation for this intern, what assets, strengths, and job skills
would you mention?
4. Wh
at skills or abilities could use improvement?
5. Additional comments on your intern or the internship experience:
Work-site Supervisor: Please review and discuss this evaluation with the student.
SIGNATURES:
____________________________________________________________ ____________________________
Work-site Supervisor Signature Date
My signature ack
nowledges that this evaluation has been discussed with me. I do not necessarily agree with the contents.
__________________________________________________________
Student Signature
____________________________
Date
Unsatisfactory
Fair Average
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signature
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INTERN FEEDBACK FORM
Intern’s Name: ___________________________________________ WNCC ID#: ___________________
Work
-site Supervisor:______________________________________ Title: ________________________
Internship Organization: ________________________________________________________________
Work-site Supervisor Contact Phone: _____________________ Alt. Phone: _______________________
Internship Faculty: __________________________________ Department: ________________________
Dates of Internship: From (mm/dd/yy) ___________________ To (mm/ddy/yy) _____________________
Indicate the degree to which you agree or disagree with the following statements:
Strongly
Agree
Agree
No
Opinion
Disagree
Strongly
Disagree
a. The orientation and training was sufficient to
familiarize me with the organization.
b. My duties were fully explained and
r
easonably in line with my learning contract.
c. The work environment was appropriate
f
or my internship activities/duties.
d. My work-site supervisor was well organized.
e. My work-site supervisor gave appropriate
feedback.
f. My work-site supervisor was accepting
of
my feedback.
g. My work-site supervisor was supportive
and perceptive.
h. My work-site supervisor set realistic goals in
terms of complexity and time restraints.
i. My classroom experience prepared me for
this internship.
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signature
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signature
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1. Comments on above responses (optional):
2. Over
all experience as an intern in this organization (circle one):
Unsatisfactory Fair Average Above Average
Excellent
3. Extent to which you feel you met or exceeded learning objectives associated with internship (circle one):
Unsatisfactory Fair Average Above Average Excellent
4. Were your internship role, the organization, and your supervisor what you expected them to be? If not,
how did your expectations differ from the reality of the placement?
5. Are there improvements/changes you would like to see in this internship placement?
__________________________________________________________
Student Signature
____________________________
Date
*****Please return to internship faculty when complete.
Do not give to your work-site supervisor.
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signature
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Phone:
INTERNSHIP AGREEMENT
WNCC ID:
Phone:
Student Name:
Email:
Interns
hip Faculty Name: Email:
T
erm: Fall 20____ Spring 20____ Summer 20____
Student agrees to intern with:
I
nternship Organization:
I
nternship Address: City, State, Zip Code:
W
ork-site Supervisor: Title:
W
ork-site Supervisor Email: Phone:
H
ours per Week Agreed to: Total Internship Hours Agreed to: Academic Credit Hours to be Earned
(determined by WNCC):
B
eginning Date: Completion Date:
S
tudent Internship Role:
Brief Description of Duties:
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signature
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signature
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LEARNING OBJECTIVES AND STRATEGIES: These items are to be completed via the cooperative
efforts of the intern and the employer. Input by both parties is crucial, and the completion of this section is
necessary for the approval of the internship. You must be specific. The student needs two (2) learning
objectives per credit hour earned. It is recommended that students utilize the SMART method to outline
learning objectives. See attached template.
Intern: I agree with all components of this learning contract; and I will adhere to the objectives, strategies, and
evaluation methods of the contract to the best of my ability.
Signature of Intern Date
Signature of Internship Faculty Date
Signature of Career Pathways & Advising Internship Coordinator Date
Work-site Supervisor: I have read this learning contract, and I attest that its components meet the expectations for an
internship with my organization. I agree to conduct a final evaluation of the intern and to participate in a site visitation if
requested.
Signature of Work-site Supervisor Date
In
ternship GPA Waiver Form
As set forth in the WNCC Internship Manual, students must have earned a 2.5 program-specific GPA
(minimum) at the time of application to participate in an internship for college credit. A program-specific GPA
is calculated using only the completed courses that are considered core requirements in a program of study.
In the event that this minimum requirement is not met, the faculty sponsor and Career Pathways and Advising
Internship Coordinator can approve internships on a case by case basis. Please complete this application and
return to the Career Pathways and Advising office.
S
tudent Name:
Student ID:
Program of Study:
Current Program-Specific GPA:
P
lease provide a brief statement explaining other qualifications you may have that should be considered for
this internship experience, and/or extenuating circumstances that may have contributed to not meeting the
minimum GPA requirement.
___________________________________________
____________
Faculty Sponsor Date
___________________
________________________ ____________
Career Pathways and Advising Internship Coordinator Date
International Student Intern Consideration Form
This form is intended to be turned in to the intern employer for their information. International students have
specific restrictions on the amount of paid hours they are allowed to work in a week when school is in session
(ie- outside of summer or any breaks during the academic year). This form outlines all paid hours being
currently worked by the student. International student paid work hours must not exceed 20 hours per week
total.
Student Name____________________________________________________
Is this individual a student worker? Yes No
If yes, how many hours per week does this individual work? __________
If yes, how many additional hours per week would this individual be eligible to work for a paid
internship for credit? _________
_____________________________________________ __________
Registrar Signature Date
click to sign
signature
click to edit
click to sign
signature
click to edit
SMART Learning Objectives Template
Internship Manual & Forms Packet
Student Name____________________________________________________________________
Internship Site____________________________________________________________________
Internship Site Supervisor___________________________________________________________
Faculty Sponsor___________________________________________________________________
SMART Learning Objectives
The acronym "SMART" stands for Specific, Measurable, Attainable, Relevant, and Timely. The
purpose of this form is to provide a format for students and employers to devise two (2) learning
objectives per credit hour of internship course. For example, a student who plans to register for three
credit hours should work with his/her employer to devise six (6) learning objectives that are relevant
to internship site activities during the performance period. The SMART template guides students,
employers, and faculty in capturing pertinent information about the actions steps and progress made
towards achieving the student’s goals as they pertain to this work-based learning experience.
Objectives should relate to student’s specific program of study
Objectives should relate to internship site work activities
Objectives should be challenging, but attainable
All objectives should be written in the SMART format
SAMPLE: During the Fall 2020 semester, student will learn to assist customers with troubleshooting
office software, including Microsoft Word and Excel, over the phone with less than a 3% error rate.
___________________________________ __________
Student Signature Date
___________________________________ __________
Employer Signature Date
___________________________________ __________
Faculty Sponsor Signature Date
Learning Objective #1:
_______________________________________________________________________________________
_______________________________________________________________________________________
_______________________________________________________________________________________
_______________________________________________________________________________________
Specific: What exactly will you accomplish?
_______________________________________________________________________________________
_______________________________________________________________________________________
_______________________________________________________________________________________
Measurable: How will you know when you have met this objective?
_______________________________________________________________________________________
_______________________________________________________________________________________
_______________________________________________________________________________________
Achievable: Is achieving this objective realistic with effort and commitment? Have you got the resources to
achieve this objective? If not, how will you get them?
_______________________________________________________________________________________
_______________________________________________________________________________________
_______________________________________________________________________________________
Relevant: How is this learning objective relevant to the internship work activities? How is it relevant to
student’s program of study?
_______________________________________________________________________________________
_______________________________________________________________________________________
_______________________________________________________________________________________
Timely: When will you achieve this learning objective?
_______________________________________________________________________________________
_______________________________________________________________________________________
_______________________________________________________________________________________
Learning Objective #2:
_______________________________________________________________________________________
_______________________________________________________________________________________
_______________________________________________________________________________________
_______________________________________________________________________________________
Specific: What exactly will you accomplish?
_______________________________________________________________________________________
_______________________________________________________________________________________
_______________________________________________________________________________________
Measurable: How will you know when you have met this objective?
_______________________________________________________________________________________
_______________________________________________________________________________________
_______________________________________________________________________________________
Achievable: Is achieving this objective realistic with effort and commitment? Have you got the resources to
achieve this objective? If not, how will you get them?
_______________________________________________________________________________________
_______________________________________________________________________________________
_______________________________________________________________________________________
Relevant: How is this learning objective relevant to the internship work activities? How is it relevant to
student’s program of study?
_______________________________________________________________________________________
_______________________________________________________________________________________
_______________________________________________________________________________________
Timely: When will you achieve this learning objective?
_______________________________________________________________________________________
_______________________________________________________________________________________
_______________________________________________________________________________________
Learning Objective #3:
_______________________________________________________________________________________
_______________________________________________________________________________________
_______________________________________________________________________________________
_______________________________________________________________________________________
Specific: What exactly will you accomplish?
_______________________________________________________________________________________
_______________________________________________________________________________________
_______________________________________________________________________________________
Measurable: How will you know when you have met this objective?
_______________________________________________________________________________________
_______________________________________________________________________________________
_______________________________________________________________________________________
Achievable: Is achieving this objective realistic with effort and commitment? Have you got the resources to
achieve this objective? If not, how will you get them?
_______________________________________________________________________________________
_______________________________________________________________________________________
_______________________________________________________________________________________
Relevant: How is this learning objective relevant to the internship work activities? How is it relevant to
student’s program of study?
_______________________________________________________________________________________
_______________________________________________________________________________________
_______________________________________________________________________________________
Timely: When will you achieve this learning objective?
_______________________________________________________________________________________
_______________________________________________________________________________________
_______________________________________________________________________________________
Learning Objective #4:
_______________________________________________________________________________________
_______________________________________________________________________________________
_______________________________________________________________________________________
_______________________________________________________________________________________
Specific: What exactly will you accomplish?
_______________________________________________________________________________________
_______________________________________________________________________________________
_______________________________________________________________________________________
Measurable: How will you know when you have met this objective?
_______________________________________________________________________________________
_______________________________________________________________________________________
_______________________________________________________________________________________
Achievable: Is achieving this objective realistic with effort and commitment? Have you got the resources to
achieve this objective? If not, how will you get them?
_______________________________________________________________________________________
_______________________________________________________________________________________
_______________________________________________________________________________________
Relevant: How is this learning objective relevant to the internship work activities? How is it relevant to
student’s program of study?
_______________________________________________________________________________________
_______________________________________________________________________________________
_______________________________________________________________________________________
Timely: When will you achieve this learning objective?
_______________________________________________________________________________________
_______________________________________________________________________________________
_______________________________________________________________________________________
Learning Objective #5:
_______________________________________________________________________________________
_______________________________________________________________________________________
_______________________________________________________________________________________
_______________________________________________________________________________________
Specific: What exactly will you accomplish?
_______________________________________________________________________________________
_______________________________________________________________________________________
_______________________________________________________________________________________
Measurable: How will you know when you have met this objective?
_______________________________________________________________________________________
_______________________________________________________________________________________
_______________________________________________________________________________________
Achievable: Is achieving this objective realistic with effort and commitment? Have you got the resources to
achieve this objective? If not, how will you get them?
_______________________________________________________________________________________
_______________________________________________________________________________________
_______________________________________________________________________________________
Relevant: How is this learning objective relevant to the internship work activities? How is it relevant to
student’s program of study?
_______________________________________________________________________________________
_______________________________________________________________________________________
_______________________________________________________________________________________
Timely: When will you achieve this learning objective?
_______________________________________________________________________________________
_______________________________________________________________________________________
_______________________________________________________________________________________
Learning Objective #6:
_______________________________________________________________________________________
_______________________________________________________________________________________
_______________________________________________________________________________________
_______________________________________________________________________________________
Specific: What exactly will you accomplish?
_______________________________________________________________________________________
_______________________________________________________________________________________
_______________________________________________________________________________________
Measurable: How will you know when you have met this objective?
_______________________________________________________________________________________
_______________________________________________________________________________________
_______________________________________________________________________________________
Achievable: Is achieving this objective realistic with effort and commitment? Have you got the resources to
achieve this objective? If not, how will you get them?
_______________________________________________________________________________________
_______________________________________________________________________________________
_______________________________________________________________________________________
Relevant: How is this learning objective relevant to the internship work activities? How is it relevant to
student’s program of study?
_______________________________________________________________________________________
_______________________________________________________________________________________
_______________________________________________________________________________________
Timely: When will you achieve this learning objective?
_______________________________________________________________________________________
_______________________________________________________________________________________
_______________________________________________________________________________________
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