Revised: July 2021
CAREER PATH INTERNSHIP (CPI) AGREEMENT FORM
All items must be completed in order for this form to be processed. Students must ensure that I-9 documents are on file with Human Resources.
The CPI Program is designed to provide students a paid, professional internship experience in their field of study that is
aligned with their major and/or career goals.
STUDENT INFORMATION
Student’s Name: ISU Email: Bengal ID:
Class Level: Major: # of credits (current semester):
Provide your (the student) career goals and/or objectives:
Are you an international student? (check one)
YES NO Country:
DEPARTMENT INFORMATION
Department: CPI Allocation (CAL, CoSE, etc.):
Start Date: End Date: Campus (check one) Pocatello Idaho Falls Meridian
Is the internship located off-campus? (check one)
YES NO
(If yes, please provide the following information)
Off-campus organization: Off-campus phone:
Off-campus supervisor: Off-campus email:
Does this internship take place in a public serving clinic? YES NO
(check one)
INTERNSHIP INFORMATION (MUST BE COMPLETED BY THE DEPARTMENT)
Provide the internship’s main duties and three student learning outcomes: (Please note that the intern’s primary duties should be
career and/or major related and NOT include clerical tasks such as filing, answering phones, etc.) Attach additional sheets if necessary.
Student Learning Outcome 1:
Student Learning Outcome 2:
Student Learning Outcome 3:
SIGNATURES
By signing below, I acknowledge that I have read and submit to the CPI program policies. Any deviation from these terms,
either by the student or department, may result in penalties that may include future exclusion from participation in the
CPI Program.
ISU Supervisor PRINTED name:
