Internship in Biological Science
BIOL*3660
Application Form
First Name:
ID Number:
No. of Credits Completed:
STUDENT INFORMATION
Last Name:
Major:
Email Address:
Cum Average:
EXPERIENTIAL LEARNING INFORMATION
Name of organzation:
Address of
organization:
Name of workplace
supervisor and
position/title:
Contact information
for s
upervisor
including email:
Duration of
experience (hrs and
weeks)
Primary focus of the
student:
Student's position
title:
Name of Academic
Evaluator
Contact
Information for
Academic
Evaluator
Brief description of
the: (student is responsible
for completing this section in
consultation with the
workplace supervisor)
1. key activities
of the position
2.
areas of science
related to these
activities or the
organization
3.
employability
skills* to be
developed through
this experience
(Min. 3 skills)
Is this
experience
paid?
YES
NO
WORKPLACE SUPERVISOR ENDORSEMENT
I have read
through the
course
requirements
YES
NO
I agree with the
deliverables as
stated above by
the student
YES
NO
I agree to provide
feedback to the
course coordinator
as required and
within the required
deadlines
YES
NO
I agree to complete
the provided
performance
evaluation as the
supervisor of the
internship
YES
NO
I would like to attend the final presentations given by the students
Yes
No
I agree to provide
feedback to the
student throughout
the experience
YES
NO
If any aspect of the experience changes the student is responsible for notifying their academic
evaluator and the course coordinator immediately.
I have completed and attached the letter to placement employers
I agree to complete and submit the pre-placement due-diligence checklist
CONFIRMATION OF CONSENT
By signing this form you confirm that you have read the requirements of the supervisor and agree
that the above information is an accurate representation of what the student will undertake during
this experience. You also acknowledge that you will provide feedback on the student's
performance based on the provided guidelines.
Supervisor's
Signature
By signing this document you confirm that you have read and agree to the requirements of the
Internship in Biological Sciences course
. You agree that you have accurately described the project
that you will undertake with this organization and that you will represent yourself and the University
of Guelph with a high level of professionalism and integrity.
Student's
Signature:
PLEASE NOTE:
If the students is undertaking an unpaid work placement and the organization is within Ontario
a letter of authorization must be completed.
Course Coordinator's
Signature:
* EMPLOYABILITY SKILLS - The College of Biological Science will be looking for students
to reference the following employability skills in their description above.
Analytical/Problem Solving
Communication
Project Management
Data Analysis
Computer/Technical Skills
Team Player/Interpersonal Skills
Business/Entrepreneurial Aptitudes
By signing this document, the course coordinator is confirming that the position, as stated above,
does qualify for enrollment in the Internship in Biological Sciences course. The coordinator is
agreeing to facilitate the logistics of the course and answer questions posed by the student and
supervisor regarding the course requirements and structure.
Academic Evaluator's
Signature
By signing this document the academic evaluator is confirming that they have read and agree to the
requirements of the Internship in Biological Sciences course. You will be responsble for providing
guidance to the student regarding the course requirements including assessment of the student’s
project and reflective assignments. You will also serve as a resource regarding content and/or provide
resources that may be able to help the student complete the required assignments.
Once the course coordinator has signed the application form, they will need to sign the University
of Guelph Course Waivrr form. The waiver form will need to be taken to the 3rd floor of the
University Centre to be processed by the Registrar's office. The Registrar's office will add the
course to the students schedule.
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