Fill - Free fillable BiologyInternshipAgreement - Biology Internship Agreement PDF PDF form

THE LANGUAGE IN THIS DOCUMENT DOES NOT CREATE AN EMPLOYMENT CONTRACT, EITHER EXPRESSED

OR IMPLIED, OR OTHERWISE ALTER THE AT-WILL EMPLOYMENT RELATIONSHIP BETWEEN ANY EMPLOYEE

AND WINTHROP UNIVERSITY. WINTHROP UNIVERSITY RESERVES THE RIGHT TO REVISE THE CONTENTS OF

THIS DOCUMENT, IN WHOLE OR IN PART, AS NECESSARY.

Biology Department

Internship Agreement

Winthrop University

Student Information (To be completed by the Intern)

Today’s Date:_____________ Number of Credits:__ Credit(s)

Class Enrolled In:___________ Semester/Year Enrolled: _________

__________________________________________________ _____________________________ @winthrop.edu

Intern Name (Print Clearly) Email (Winthrop email will be primary method of communication)

_________________________ ______________________ ____________________________

Phone Number Student ID # Class/Graduation Year

_________________________ _____________________ ____________________________

Major Minor Concentration Faculty Liaison

Are you legally authorized to hold a paid off-campus internship in the U.S.? Yes ☐ No ☐

Internship Site Information (To be completed by Internship Supervisor) For Profit ☐ Not for Profit ☐

_________________________________________________ ___________________________ ____________________

Organization Name Business License # or FEIN # State Issued

(do not provide a SS#)

_________________________________________________ ___________________________________________________

Direct Internship Supervisor Supervisor’s Title

___________________________________________________________________________ Available for site visit? Yes ☐ No ☐

Physical Address

_________________________________________________ ____________________________________________________

Supervisor Phone Supervisor Email

Internship Projected Start Date: _________ Internship Projected End Date: __________

Est. Total Number of Weeks: ___________ Est. Total Hours/Week: ____________

Paid: Yes ☐ No ☐ If yes, $_______/________

Additional Compensation/Stipend: ________________________________________________________________________________

Internship site/supervisor accepts sole responsibility for determining the existence of an employment relationship as described by the

Fair Labor Standards Act (FLSA) Field Operations Handbook and for compliance with the FLSA and other state and federal wage-

related laws and regulations.

For Office use only:

Date Received ________ Correspondence sent to employer ☐ Correspondence sent to student ☐

Est. Mid-Point _________________

Other: _____________________________________________________________________________________________________

LEARNING AGREEMENT: Internship Job Description (To be completed by Internship Supervisor)

Attach a separate sheet for an actual job description if available. The job description is to be determined by the

Internship Supervisor, the approved by the faculty liaison (Dr. Courtney Guenther), and the de

partment chair (Dr. Dwight

Dimaculangan). The Inter

nship Supervisor should use the space below to describe the tasks, projects and learning

outcomes for the intern in as much detail as possible. This will serve as the written agreement between all parties

involved. Internship Agreement is not valid until approved by all parties.

Intern Tasks/Role:

Specific Projects Intern will work on/assist with:

Learning Outcomes for Intern:

Additional Comments regarding Internship:

I have read the agreement and will fulfill the duties and responsibilities outlined for the internship and the academic requirements for

completing the internship course for credit.

________________________________________________________________ ___________________

Intern’s Signature Date

I approve of and agree to the Learning Agreement. I agree to abide by all the Equal Opportunity/Affirmative Action and other related

federal and state laws and regulations in the hiring of Winthrop University students. I agree that the company will instruct/orient the

student on company policies/procedures, and provide a safe working environment.

________________________________________________________________ __________________

Internship Supervisor’s Signature Date

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PERSONAL LEARNING GOALS (To be completed by the intern)

Answer the following questions to complete your internship application for your particular site.

These answers in addition to your Learning Agreement must be reviewed and approved by your faculty liaison.

Once the Learning Agreement and Personal Learning Goals are completed and approved, bring them to

Dr. Courtney Guenther's office (Dalton 106) to finalize your internship.

1. Explain how this internship will add to your educational experience at Winthrop University.

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2. What professional and personal goals do you hope to achieve while at this internship? (Be specific)

FACULTY LIAISON (Please sign below):

Listed below are specific assignments that will be required of all students completing an internship in order to satisfactorily

complete the experience and receive academic credit. Please indicate any other assignments that will be required during

this work experience:

Required: 1. Internship Learning Agreement Form 4. Work Hour Log (Journal)

2. Mid-Point Evaluation 5. Final Summary Evaluation

3. Participation in Site Visit (if possible) 6. Letter From Supervisor

Other: See Syllabus

I approve of the Learning Agreement & Personal Learning Goals. Learning agreement is valid for course credit.

___________________________________________________________ ____________

Faculty Liaison Signature Date

___________________________________________________________ ____________

Student Signature Date

___________________________________________________________ ____________

Department Chair Signature Date

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General Responsibilities of the Parties:

1. Student responsibilities:

a. Work on the days & times agreed upon with supervisor

b. Dress in the appropriate attire for the internship site

c. Watch the CCE orientation video at www.youtube.com/watch?v=W2XIz-1-_cw&feature=youtu.be

d. Your safety is important. If you ever feel unsafe, harassed, or discriminated against at the site you

may leave on your own free will. The student should contact the internship coordinator and/or site

supervisor with concerns even if you are not sure.

e. Complete tasks and projects associated with the learning outcomes

f. Complete all assignments

g. Communicate with all parties if length of the internship needs to be adjusted in order to complete the

hours requirement

h. DISCLAIMER:

Please note that the presence of job announcements on any website, list serve, bulletin or other

communications maintained by Winthrop University does not indicate an endorsement or

recommendation by Winthrop University or CCE. We are not responsible for safety, wages, working

conditions or other aspects of off-campus employment. We do not conduct a background check on

employers - so make sure you spend time researching before you apply.

2. Faculty liaison or designee responsibilities:

a. Meet with the student interested in an internship and discuss the internship requirements

b. Check with employer to confirm the intern’s role

c. Send initial correspondence and follow-up emails at the mid-point and at the conclusion of the

internship

d. Be a sounding board for interns and site supervisors

e. Be vigilant! Listen for any safety and security concerns the students may have, and TAKE ACTION

to report or intervene if appropriate.

3. Site supervisor responsibilities:

a. Follow the Fair Labor Standards Act for internships (www.dol.gov/whd/regs/compliance/whdfs71.htm)

b. Orient intern on the culture of the site

c. The safety of our students is of utmost importance. Students/interns are directed to report any safety

or workplace concerns to their faculty liaison or to Career and Civic Engagement. Internship

sites/supervisors are required to provide a safe environment and to abide by all federal and state

workplace laws and regulations in agreeing to accept an intern from Winthrop University into their

workplace.

d. Explain work place expectations to the intern

e. Provide the student/intern and the faculty liaison or designee with any applicable policies or

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