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Student Information
Name__________________________
Major ____________________________ Expected Graduation Date________
Telephone_________________________ Email_________________________
Title of Internship_________________________________
Company/Supervisor Information
Company_________________________ Department________________________
Supervisor Name_________________ Title_____________________________
Telephone_______________________ Email_____________________________
Schedule of Internship
Begins__________________________ Ends______________
Hours to work per week_____
Monday
Tuesday
Wednesday
Thursday
Friday
Sat/Sun
Hours
Payment (check one)_____Paid_____Unpaid*
If paid internship, provide amount of payment: $ _______
* If unpaid please read http://blog.capital.org/the-six-criteria-for-unpaid-interns/ for guidelines
When students are enrolled in Cooperative Education classes at Cuesta College, the following
applies:
1. All students are charged a mandatory health service and accident fee which covers
them for free health services at both the Main campus and the North County campus.
2. Cuesta College carries a comprehensive liability policy.
Cooperative Education students working on a non-paid basis are covered by Cuesta
College’s Workers’ Compensation policy (Ed. Code 78249)
3. Any work done outside of the scheduled semester dates will not be covered under
Cuesta College’s Liability Policy.
Appointment
1. The Appointment is for an initial period ___________of expiring
on_______________, unless otherwise terminated earlier by either
party upon two weeks written notice.
2. It is understood that the Appointment precludes the student from
being considered as a worker or employee of the Company and that
the undertaking of the Appointment is on a genuine volunteer
basis.
3. The Internship is related to an educational purpose and there is
no guarantee or expectation that the activity will result in
employment with the Company.
General Responsibilities of the Parties
Student will have the following Responsibilities
1. To observe all applicable rules, regulations, instructions,
procedures and directives of the Company;
2. To behave in a professional manner at all times and to conform to
the regulations and dress code of the organization in which
internship takes place.
3. To work on the days and times agreed upon and to work hard and
diligently throughout the Appointment. If an absent is to take
place notify supervisor.
4. To complete the projects and assignments given to you in a timely
and accurate manner.
5. Notify Cuesta College Coordinator or Faculty Advisor should any
problems arise during the course of the internship.
6. Complete the required log of hour’s sheet and submit to Cuesta
College Coordinator at end of internship.
7. To provide immediate notification to the Company of any illness
or circumstance that will mean missing any day or part of your
internship.
8. To keep confidential any and all unpublished and confidential
information made known to you during the course of the
Appointment; not to publish any reports or papers on the basis of
information obtained during the Appointment, both during and
after the completion of your internship.
Cuesta College will have the following responsibilities
1. Identify faculty mentor that will advise student for
Cooperative Work Experience
2. Participate in planning and evaluation regarding learning
activities by jointly deciding on goals with student and
supervisor.
3. Provide company/supervisor with student evaluation forms.
4. Notify student of obligations and monitor students’ compliance
during the course of the internship.
5. Conduct intermittent individual contacts with students during
internship to critique student progress and professional
growth.
6. Contact the business if student has dropped the course and is
no longer covered under Cuesta College’s Liability Insurance.
The company/supervisor will have the following responsibilities
1. Provide a working environment which allows the student to gain
experience relevant to the major field.
2. Supply a safe environment for the student and inform student and
Cuesta College of any possible unsafe conditions.
3. Assist both student and Cuesta College Coordinator in developing
goals to be completed during internship.
4. Notify Cuesta College Coordinator of any poor work performance or
problems with the student placement.
5. Evaluate student’s performance at the end of internship and
submit evaluation form to Cuesta College Coordinator.
6. Keep Student’s academic information confidential in accordance
with FERPA (Family Educational Right to Privacy Act).
Please confirm this agreement to the above by signing.
Company:
________________________
________________________
For and on behalf of _____________________
Student:
I have read and agree to the above terms regarding my appointment as a
volunteer intern of _____________________
________________________ ____________________
________________________ Date
Requirements of the Intern to be considered
Provide a description of the qualifications of the intern you will
consider before being considered for the appointment. Provide any
additional educational requirements that will be required during the
appointment.
Intern Job Responsibilities
Provide a description of student intern responsibilities, including
both daily responsibilities and broader assignments to be completed
during the course of internship experience.
Goals and Objectives
Provide a description or list of intern’s goals and objectives to be
completed by end of internship based on professional development.
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Completed 15 March 2020

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