Fillable Form 1.: LEARNING CONTRACT & INTERNSHIP PROPOSAL (State University of New York at Plattsburgh)

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Form 1.: LEARNING CONTRACT & INTERNSHIP PROPOSAL (State University of New York at Plattsburgh)

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LEARNING CONTRACT & INTERNSHIP PROPOSAL
SUNY Plattsburgh
INSTRUCTIONS
1.
Please type information in the form below then print page to obtain signatures.
2. Prepare a preliminary draft of this learning contract and internship proposal. (See Sections II, III, and IV on reverse.)
3. Discuss your duties as an intern with your site supervisor.
4. Present your transcript (available on Banner Web), draft proposal, and this contract to your faculty sponsor for
discussion.
5. After the faculty sponsor approves your draft, prepare a final version.
6. Obtain ALL signatures and submit this form to the dean of your sponsor’s faculty. If approved, copies of this form will
be distributed by the dean’s office to: student, faculty sponsor, and department chairperson.
7. You must complete the Felony Questionnaire. Information at https://web.plattsburgh.edu/felony
GENERAL INFORMATION
Student’s Name: _
____________________________________________ Student’s ID: __________________
Local Address: ______________________________________________ Phone No.:_____________________
SUNY Plattsburgh Email: _____________________@plattsburgh.edu
Address During Placement: ________________________________________________________________________
In what state (New York, Vermont, etc.) will this internship take place? _____________________________________
Major(s):___________________________________________________ Class Level: ____________________
COURSE SUBJECT AND NUMBER:
_____________NUMBER OF CREDITS FOR PROPOSED INTERNSHIP: ____________
INTERNSHIP TITLE: _______________________________________
Date internship begins*: ____________________ Date internship ends: _____________________
*Begin date determines which semester course is created/billed*
Internship is: Full-time—No. hours/week: ______ Part-time—No. hours/week: ______
Site Supervisor’s Name (print):________________________________________________________________
Credit for the internship will apply as: Major credit Minor credit Elective credit
Method of Grading: Pass/Fail Letter grade
Total number of internship credits completed prior to this proposal: ________
Total number of credit hours to be registered for this semester, including proposed internship: _________*
Faculty Sponsor’s Name: __________________________________________ Phone No.:_______________
PLEASE PRINT
Signatures must be obtained in the following order:
Yes No
Indicate Approval in Email
Faculty Sponsor ________________________________________________________ Date _________
Academic Advisor _____________________________________________________ Date:_________
Indicate Approval in Email
Chair (of department offering course): ___________________________________ Date: ________
Indicate Approval in Email
Site Supervisor's Signature: _____________________________________________ Date: ________
Indicate Approval and Insurance Answer in Email
Does your site require student liability insurance? Yes No
Dean (of division offering course): ______________________________________ Date: ________
Indicate Approval in Email
*CREDIT OVERLOAD APPROVAL
Yes No
Chair (of student's major): _____________________________________________ Date: ________
Indicate Approval in Email
Dean (of student's major): _____________________________________________ Date: ________
Indicate Approval in Email
Dean’s Office distributes copy of first page to Registrar’s Office for registration processing VPAA 02/2018
ATTACH RESPONSES TO SECTIONS II, III, AND IV
II. INTERNSHIP POSITION DESCRIPTION
a. Location of the placement – name, address, phone.
b. What are the specific duties entailed in your internship? Include day-to-day tasks and specific projects,
reports, attendance at conferences, special meetings, etc.
III. EDUCATIONAL GOALS AND OBJECTIVES
a. Why is the internship being undertaken?
b. What are your specific goals and objectives?
c. What are your expected learning outcomes in terms of the application of theory or a method of inquiry,
acquisition of professional knowledge, or development of specific skills, etc.?
IV. METHODS OF EVALUATION
a. How will your agency supervisor evaluate your performance? How often and in what format?
b. Will the agency supervisor’s evaluation be used in determining a final grade? If so, how?
c. What evidence can be provided to demonstrate that your educational goals and objectives have been
achieved?
d. What evaluation data will your faculty sponsor require? For example:
- research paper(s): documentary, analytic, creative
- journal or log of activities, thoughts, impressions, analysis
- written reports, essays
- reports, papers, materials written for the agency
- written or oral expression
- reading lists
- other (explain)
e. What contacts will you have with your faculty sponsor (on-site visit(s) by your faculty sponsor or
consultation in person, by phone or mail) and how often?
f. Interns are required to do a written evaluation of the placement site. Give this evaluation to the faculty
sponsor at the end of the internship period.
GUIDELINES FOR INTERNSHIPS AND COLLEGE-SPONSORED EXPERIENTIAL EDUCATION*
SUNY Plattsburgh
REQUIREMENTS
1. A student receiving credit for an internship must have a faculty sponsor and an agency supervisor for
the internship.
2. Interns are required to work in the internship placement for at least three hours per week (15 weeks)
for each academic credit hour. Internships may be full or part-time, paid or unpaid.
3. The specific field duties and responsibilities of the intern will be agreed to by the faculty sponsor, the
agency supervisor, and the intern, and they will be outlined in the learning contract.
4. Specific academic requirements appropriate to the placement will be established by the faculty sponsor
and specified in the Learning Contract.
ADMISSIONS STANDARDS
1. Students wishing an internship for credit must have junior, senior, or graduate class standing. The
minimum GPA for participation in an internship shall be established by the sponsoring department.
Departments may establish prerequisite courses and minimum GPA in these courses.
INTERNSHIP CREDIT
1. Course Credit – Interns will be enrolled under a department course: Dept. 498 (or Dept. 598) Internship
– Title. Students may take internships for major, minor, concentration, or elective credit Academic credit
may range from one credit hour to a maximum of 15; any departmental policies on the maximum or
minimum number of internship credits used to meet major, minor, or concentration requirements apply.
Failure to complete all requirements of the internship will lead to an incomplete (policy pertaining to “I”
grades will apply), or an unsatisfactory/failing grade will be given by the faculty sponsor.
2. Credit toward the baccalaureate: Usually, the total number of credits awarded for internships may not
exceed 18 toward the fulfillment of the credit hours required for a bachelor’s degree. The suggested
limit of 18 hours does not include any credit taken by interns in related courses such as a seminar that
may be taken in tandem with the internship. More than 18 credit hours of internship may be earned if
the hours beyond the limit are in addition to the credit hours required for graduation.
3. Credit Hours – No more than one credit hour can be awarded for each 45 hours of internship work, 3
hours per week x 15 weeks.
QUESTIONS TO BE CONSIDERED WHEN APPROVING INTERNSHIP REQUESTS
1. Does the student have the capacity (intellectual level of maturity, independent work habits, etc.) to
undertake an internship?
2. Does the student possess sufficient background in terms of course work to successfully pursue this
internship?
3. Does the student have the required grade point average?
4. Does the placement provide the student adequate opportunity to achieve the proposed objectives?
*Based upon Faculty Senate Policy, May 1983.
Student Liability Insurance
The State University of New York has partnered with Ironshore Indemnity, Inc. to provide student liability
insurance for eligible students. The purpose of the student liability policy is to cover State University of New
York enrolled students participating in a clinical or non-clinical training program at an outside facility or at
SUNY facilities. In order for the clinical or non-clinical training program to be included under the policy, all of
the following criteria must be met:
1. The student must receive academic credit or be meeting a course or program requirement
2. The training must be supervised by the training site and a faculty member
3. There is an affiliation agreement in place between SUNY and the training program site
4. The affiliation site must require insurance
5. The program must be approved by the company for coverage under the policy
This liability insurance policy will cover students who are named as a party of legal action arising from their
participation in a program that meets the criteria described above. The policy will pay those sums that the
student becomes legally obligated to pay as a result of “bodily injury” or “property damages” covered by the
policy including associated legal expenses. This coverage does not indemnify the clinical/non-clinical training
site, location or host entity. This policy does not insure any licensed professionals acting in that capacity.
Site supervisors who indicate an affirmative response to the student liability insurance question will be sent an
affiliation agreement for review and approval. Questions about this matter should be addressed to SUNY
Plattsburgh’s Management Services Office
at (518) 564-2538.
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Form 1.: LEARNING CONTRACT & INTERNSHIP PROPOSAL (State University of New York at Plattsburgh)

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Completed 27 August 2020

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