Fillable Professional Internship Program SPARK Grant Supervisor Approval Form (Nazareth College)

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Professional Internship Program SPARK Grant Supervisor Approval Form (Nazareth College)

On average this form takes 14 minutes to complete

The Professional Internship Program SPARK Grant Supervisor Approval Form (Nazareth College) form is 3 pages long and contains:

  • 4 signatures
  • 10 check-boxes
  • 36 other fields

Country of origin: US
File type: PDF

U.S.A. forms for Nazareth College

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Professional Internship Program
SPARK Grant Supervisor Approval Form
This!agreement!confirms!the!details!of!the!internship!and!the!intent!of!the!student!to!receive!
Nazareth!SPARK!Grant!funding!for!the!experience.!Students:!Submit!a!signed!copy!of!this!form!
with!your!SPARK!Application.!
!
Student!Name:!! _______________________________________!
Student!ID!Number:!! _______________________________________!
!
First!Name:!____________________________!!!Last!Name:!_______________________!
Company!Name:!_________________________!!Website:!________________________!
Title:!__________________________________!!!Phone:!_________________________!
Email:!________________________________________________!
!
Student!Position:!____________________________________________!
Internship!Location:!!☐!Company/Org!office!!!!☐!Offsite/remote!location!(please!specify)!
Street!Address:!!________________________________________________!
City:!!___________________________!!!State:!_______________! Zip:!______________!
! Will!the!intern!receive!any!compensation!for!this!experience?!
! ☐ Internship!is!unpaid!
☐!!Salary:!$___________/hour! ☐!!Stipend:!$!__________/summer!
! ☐!!Other!benefits!_________________________________________________________!
Position!Description!(Describe!the!specific!job!duties,!expectations,!and!project!work.)!You!
may!attach!a!separate!document!if!preferred.!
!
______________________________________________________________________________!
______________________________________________________________________________!
______________________________________________________________________________!
______________________________________________________________________________!
!
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Student!!
Information!
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Supervisor!
Information!
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Internship!!
Descri ption!
!
!
Start!Date:!_________________________! End!Date:!________________________!
!
!!!!!! Weekly!Hours:!! Start!Time! ! ! !!!!!!End!Time!
Monday!!! ! _____________________! !!!!!!!____________________!
Tuesday! ! _____________________! !!!!!!!____________________!
Wednesday! !!!!!!!_____________________! !____________________!
Thursday! !!!!!!!_____________________! !____________________!
Friday! ! !!!!!!!_____________________! !____________________!
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Total!Hours/Week:!________________! Total!Weeks:!_______________!
!
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Nazareth!considers!employers!to!be!educational+partners:!mentoring!students,!teaching!
real-world!skills!and!preparing!graduates!to!enter!the!job!market.!To!ensure!that!an!
internship!is!a!"guided!learning!experience",!and!thus!eligible!for!SPARK!Grant!funding,!
the!following!criteria!must!be!met.!Please!initial!next!to!each!statement!to!confirm!your!
commitment.!
_______
!Regular!Supervision.!Please!discuss!with!the!student!what!supervision!will!look!
like!for!you!and!your!student!(face-to-face,!remote!check!ins,!daily,!weekly,!etc.).!
_______
!Meaningful!Feedback.!To!develop!as!young!professionals,!our!interns!count!on!
your!feedback!on!their!work.!Please!discuss!your!preferred!feedback!methods!with!your!
student.!
_______
Educational!Opportunities.!In!addition!to!the!work!they!contribute!to!your!
organization,!students!benefit!from!learning!through!observation!and/or!participation!in!
professional!meetings,!conferences,!professional!development!sessions,!etc.!We!
encourage!you!to!invite!students!to!as!many!of!these!opportunities!as!possible.!
_______
Institutional!Communication.!Communication!between!Nazareth!College,!the!
host!organization,!and!the!student!can!be!the!key!component!to!a!successful!internship!
experience.!Nazareth!will!ask!for!feedback!from!the!Internship!Supervisor!at!the!start,!
midpoint,!and!end!of!the!internship.!We!will!also!seek!out!the!supervisor!as!a!first!point!of!
contact!in!the!case!of!any!issues!that!need!to!be!resolved.!
Your!signature!indicates!that!you!agree!to!supervise!the!student!in!the!position!described.!
Supervisor’s!Signature:!__________________________________!Date:!_____________!
Student’s!signature!indicates!that!he/she!agrees!to!the!details!outlined!in!this!document.!
Student’s!Signature:!____________________________________! Date:!_____________!
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Internship!
Supervisor!
Responsibilities!
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Student!!
Work!
Schedule!
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Signatures!!
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8865954_1
PROFESSIONAL INTERNSHIP PROGRAM:
COVID-19 ACKNOWLEDGEMENT
Supervisor: Nazareth College has approved this student’s internship with the understanding that
the site is following all applicable federal, state, and local requirements regarding business
operations during the COVID-19 pandemic. If at any time you have concerns with accuracy of this
statement, immediately contact the Internship Program at internships@naz.edu or 585-389-2878.
By signing below, I acknowledge that I have read and understand the above statement.
Supervisor’s Signature: _____________________________ Date: ___________
Student: During the COVID-19 pandemic, your internship site may be required to follow certain
federal, state, and local requirements in order to protect health and safety. Nazareth College does
not exercise any control over your internship site or the specific safety protocols adopted by the
site in response to the COVID-19 pandemic. Nazareth College strongly recommends that you
follow the specific safety protocols established by your internship site, including those temporarily
place due to the pandemic.
By signing below, I acknowledge that I have read and understand the above statement.
Student’s Signature: _______________________________ Date: ___________
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Professional Internship Program SPARK Grant Supervisor Approval Form (Nazareth College)

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Completed 12 May 2021

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