This agreement must be filled out COMPLETELY, signed and returned to
the Office of Career Services before you start your internship. Questions?
Contact the Office of Career Services in the Bair Family Student Center or
at 406.657.1039 or careerservices@rocky.edu.
April 2015
Student Internship Learning Contract
Internship End Date:_____________________________
Academic Semester ___________(SEM)/__________(YR)
Internship start date: _______________________
Course #:____ _/450
Total Number of credits: _________
Work Hours: _______________ (Must work 45 hours per credit.)
Internship Student’s Name:___________________________________ Are you a U.S. citizen? Yes ___ No ___
Phone:__________________________ Email:_______________________________________________
Major_________________________ Minor ____________ Anticipated Graduation Date:_________________
On-Site Supervisor’s Name and Title: _________________________________________________________
Organization:____________________________________________________________________________
Address: _____________________________ City: __________________ State: _________ Zip: __________
Email:______________________________________________
___________
STUDENT RESPONSIBILITIES:
I will fulfill the tasks and responsibilities assigned by my on-site supervisor and outlined in this learning agreement. I
will conduct myself in a professional and ethical manner at all times.
As an intern with the organization listed above, I will treat all knowledge, information, and material gained through
my work assignment so as to protect its confidentiality. I understand that information acquired and compiled in the
course of my work assignment is the sole property of the organization, and I agree to make no public release of any
portion thereof, nor shall I publicly discuss or distribute any information as to compromise its confidentiality.
I also understand that the awarding of an internship does not guarantee or imply any future employment
opportunities with this organization.
I understand my grade will be based, in part, on evaluations by my on-site supervisor and any assignments required
by my faculty internship supervisor.
I will contact the Office of Career Services and my faculty supervisor in a timely manner of any changes to the
Learning Contract or if any problems arise and ensure that all evaluations are returned to the Office of Career
Services by the deadline.
I understand and agree to comply with the RMC Student Employment/Internship Insurance Guidelines, found at
rocky.edu/student-life/career-services/internships
I have read, understand and agree to abide by the guidelines described above.
_____________________________________ __________________________
Student signature Date
BSA
Phone number:_______________________
Paid If Paid, wage _____________ Unpaid
Attach a job description or description of tasks and responsibilities to be completed during the internship.
Learning Outcomes of Internship - to be developed by student and faculty PRIOR to supervisor signature
A.
Demonstrate effective problem solving and critical thinking
B.
Articulate an understanding of the connection between coursework and the internship experience
C.
Demonstrate professional skill in the discipline(s) associated with the internship
D.
Practice professional habits and engage in professional behavior
E._____________________
Communicate effectively orally and in writing
_________________________ ______
Student Internship Learning Contract April 2015
STUDENT INTERNSHIP CHECKLIST:
Submit the original contract to Office of Career Services by the deadline. Provide a copy to your on-site supervisor as well.
Ensure your health care coverage is current and up-to-date
Be sure your internship supervisor completes mid-term and final evaluations and submits them to Office of Career Services
Complete a time sheet and submit to Office of Career Services at the completion of the internship
Complete academic assignment for your faculty supervisor
Complete the internship self-evaluation form and submit to Office of Career Services at the completion of the internship
ON-SITE INTERNSHIP SUPERVISOR RESPONSIBILITIES:
Verify that the position and duties meet RMC internship criteria.
Comply with all federal and state laws regarding nondiscrimination and sexual harassment.
Confirm proposed Learning Outcomes are reasonable expectations for the internship and provide a complete job
description to the student and Office of Career Services.
Provide the student with supervision, training, and the resources necessary to perform assigned tasks.
Provide written evaluation of student at mid-term and upon completion of the internship. The evaluations will be
sent electronically to the employer by the Office of Career Services.
Immediately notify the RMC faculty internship supervisor and/or Director of Career Services should any problems
arise or early termination of the internship become necessary.
Comply with the RMC Student Employment/Internship Insurance Guidelines, found at http://rocky.edu/student-
life/career-services/internships/
___________________________________
Supervisor’s signature Printed Name Date
FACULTY INTERNSHIP SUPERVISOR RESPONSIBILITIES:
Approve the number of credits, work hours, length of internship and proposed learning outcomes and related tasks
and responsibilities of the internship.
Keep in contact with student throughout internship to offer guidance and support.
Assign the student an academic assignment in conjunction with the internship.
Submit student’s grade based on successful completion of an academic assignment, required hours and the intern’s
performance as evaluated by the internship on-site supervisor.
Academic Assignment:__________________________________________________ Due Date:____________________
___________________________________ ___________
Faculty Supervisor’s signature Printed Name Date
RMC OFFICE OF CAREER SERVICES RESPONSIBILITIES:
Maintain all appropriate internship records, forms and evaluations.
Facilitate communication with student, employer and faculty throughout internship. Conduct internship site visits
when appropriate and allowable by intern work schedule and location.
Distribute and collect evaluation forms twice during the semester. The forms are to be completed by
the on-site supervisor at mid-term and upon completion of internship and by the student upon completion of the
internship.
Distribute a copy of the internship contract to the Office of Student Records for course registration and
copies of all evaluations to the faculty supervisor.
Forms received by Office of Career Services: ____________________ ____________________
Initials Date
(For student's own use to track completion of internship requirements.)
___________________________
James Smith