Fillable CPI Agreement Form (Idaho State University)

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CPI Agreement Form (Idaho State University)

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Revised: December 2017
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 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? (circle one)
Country:
DEPARTMENT INFORMATION
Department:
CPI Allocation (CAL, CoSE, etc):
Anticipated Start Date:
Anticipated End Date:
Is the internship located off-campus? (circle one)
YES NO (If yes, please provide the following off-campus information)
Off-campus organization:
Off-campus phone:
Off-campus supervisor:
Off-campus email:
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 terms of the CPI Program Guidelines. 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.
Student PRINTED name:
Signature:
Date:
ISU Supervisor PRINTED name:
Signature:
Date:
UBO PRINTED name:
Signature:
Date:
Dean/VP PRINTED name:
Signature:
Date:
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CPI Agreement Form (Idaho State University)

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Completed 27 July 2020

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