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Student’s Self-Procured Internship for Academic Credit
Page 1 of 7
Internship Agreement
(Full name of student)
This agreement (“Agreement”) between the Trustees of the California State University on
behalf of California State University Channel Islands (“University”) and
(“Internship Site”) sets forth the priorities
(FULL name of Internship Site)
and responsibilities of the University and Internship Site, as they relate to the student’s self-
procured internship, for which the student will receive academic credit.
This Agreement will become effective upon its execution by both Internship Site and
University, for the specific period beginning on , 20 , and ending
on, , 20 , or until terminated by either party after giving the other
party 30 days advance written notice of the intention to terminate; however, any such
termination by the Internship Site will not be effective against any participating student until
the Student has completed the internship term or as mutually agreed upon by the parties.
In consideration of the mutual promises and conditions set forth below, the University and
the Internship Site agree as follows:
I. PRIORITIES
A. Meaningful Learning Experience
1. The Internship Site will provide the University’s student with a student-focused
learning experience that also meets the stated needs of the Internship Site.
2. The Internship Site and the University will meet as necessary to facilitate a mutually
beneficial experience for all involved or at the request of any of the parties involved.
3. Prior to the start of an internship, the Internship Site will provide University
with an accurate and complete written description of the student’s tasks and
Student’s Self-Procured Internship for Academic Credit
Page 2 of 7
responsibilities. University will be responsible for disseminating such description to
students, as appropriate. The Site will also provide the resources necessary for
student to complete these duties in a timely and efficient manner.
4. The University will work closely with the Internship Site to meet the expectations
and priorities of the Internship Site.
B. Safe and Productive Learning Environment
1. To achieve its desire to provide a safe and productive environment for the University’s
students, the Internship Site will:
a. Give student a tour of the relevant facilities at the internship site.
b. Inform student of all relevant safety policies and emergency procedures.
c. Discuss with student the reasonably foreseeable risks associated with the
internship site and the tasks and responsibilities the students have been
assigned.
d. Ensure that student will not be required or permitted to drive any vehicle as
part of their internship activities or assignments.
e. Notify the University’s Risk Management office at (805) 437-8846 as soon as is
reasonably possible of any injury or illness to a student participating in a learning
activity offered by the Internship Site.
f. Determine if a student must be fingerprinted. If fingerprinting is necessary, the
Internship Site will obtain the fingerprints, request criminal background
clearance from the appropriate agency(ies), and maintain the confidentiality of
any results as required by federal or state law.
g. Determine if a student must have a Tuberculosis (TB) test. If TB testing is
required, the Internship Site will arrange for a TB test and maintain the
confidentiality of any results as required by federal or state law.
2. The Internship Site may dismiss a student if the student violates its standards,
mission or goals. The Internship Site will document in writing its rationale for
terminating a student and provide the University with a copy of the rationale.
II. STRUCTURE AND SUPPORT OF STUDENT LEARNING AT THE
INTERNSHIP SITE
A. Site Supervision. Prior to the start of the internship, the Internship Site will inform
student of who will be responsible for his/her supervision and safety while on site. The
supervisor will meet with the student as necessary to facilitate the student’s learning
Student’s Self-Procured Internship for Academic Credit
Page 3 of 7
experience and professional development, provide support, and review progress on
assignments and activities. The supervisor will communicate as necessary (twice per
semester recommended) with the University staff or faculty member who assigned the
internship. If the supervisor is absent, the Internship Site will identify an alternate
supervisor.
B. Training and Orientation. The Internship Site will provide student with specific
training needed prior to his/her working with clients or providing service. The Internship Site
will provide student with an orientation, which should include an introduction to staff, a
description of the characteristics of the Internship Site’s operations and clients, and
information detailing where student is to check-in and how student should log his/her time.
C. Work Space. Student will have an appropriate space at the Internship Site in which to
conduct their assigned work. The Internship Site will provide access and training for any and
all equipment necessary for students to fulfill their service role.
D. Evaluation. The Internship Site supervisor will fill out survey(s) regarding the
performance of the student if requested by the University.
E. Position Description. The Internship Site will develop a position description for each
internship opportunity. Unless approved by the University, clerical or non-professional tasks
may consist of no more than 20% of the student’s total responsibilities.
F. Training and Reflection. The University will provide an orientation for student
regarding the responsibilities set forth in Section I and will provide opportunities for student
to reflect upon the experience of working at the Internship Site.
III. GENERAL PROVISIONS
A. Insurance
1. The Internship Site will maintain General Liability Insurance, comprehensive or
commercial form, with at least a $1,000,000 minimum limit for each occurrence
and at least a minimum limit of $2,000,000 General Aggregate; Workers’
Compensation Insurance covering its employees at statutory minimum levels;
Employer’s Liability Insurance with at least a $1,000,000 minimum limit for each
occurrence; and Automobile Liability Insurance with at least a $1,000,000
minimum limit for each occurrence. This insurance must be placed with insurers
with a current A.M. Best rating of no less than A: VII. The Internship Site will
provide evidence of insurance upon request.
2. The University has elected to be self-insured for its General Liability.
3. University warrants that it carries student professional liability insurance covering
University and students enrolled in required, credited coursework with a reputable
insurance company which insures the perils of general liability, professional
liability and educators errors and omissions liability (excluding premises coverage),
Student’s Self-Procured Internship for Academic Credit
Page 4 of 7
with limits of at least one million ($1,000,000) each occurrence.
B. Indemnification. University shall defend, indemnify and hold Internship Site and its
directors, officers, employees, agents harmless from and against any and all liability, loss,
expense (including reasonable attorney’s fees), claims for injury or damages arising out of
the performance of or in connection with this Agreement, but only in proportion to and the
extent such liability, loss, expense, attorney’s fees or claims for injury or damages are caused
by or result from the improper conduct, negligent or intentional acts or omissions of
University, its directors, officers, employees, or agents.
Internship site shall defend, indemnify and hold University and its directors, officers,
employees, agents and students harmless from and against any and all liability, loss expense
(including reasonable attorney’s fees), claims for injury or damages arising out of the
performance of or in connection with this Agreement, but only in proportion to and to the
extent of such liability, loss, expense, attorney’s fees, or claims for injury or damages are
caused by or result from the improper conduct, negligent or intentional acts or omissions of
Internship Site, its directors, officers, employees, or agents.
C. Independent Status. The parties, in the performance of this Agreement, will act in an
independent capacity and not as officers, employees or agents of the other. While each party
may (or may not ) be required under the terms of this Agreement to carry Workers’
Compensation Insurance, the parties are not entitled to unemployment or Workers’
Compensation benefits from the other.
D. Status of Students. Student participating in an internship is not an officer, employee,
agent or volunteer of the University.
E. Governing Law. This Agreement will be construed in accordance with, and its
performance governed by, the laws of the State of California.
F. Assignment. Without written consent of either party, this agreement is not assignable by
either party either in whole or in part.
G. Alteration and Integration. This Agreement may not be altered unless both parties agree
in writing. No oral understanding or agreement not incorporated in this Agreement is binding
on either party.
H. Endorsement. Nothing contained in this Agreement may be construed as conferring on
either party any right to use the other party’s name(s) as an endorsement of a product/service
or to advertise, promote or otherwise market any product or service without the prior written
consent of the other party. Moreover, nothing in this Agreement may be construed as
endorsement of any commercial product or service by the University, its officers or
employees.
I. Survival. Upon termination of this Agreement for any reason, the terms, provisions,
representations and warranties contained in this agreement survive expiration or earlier
termination of this agreement.
Student’s Self-Procured Internship for Academic Credit
Page 5 of 7
J. Severability. The parties agree that if any provision of this Agreement is held to be
unconscionable or invalid under any applicable statute or rule of law, that provision will be
omitted from this Agreement. However, the balance of the Agreement will remain in full
force and effect.
K. Fair Labor Standards Act and Displacement of Organization Employees. Student
participating in an internship may not perform services that would displace or replace regular
employees of the Internship Site.
L. Nondiscrimination. During the performance of this Agreement, the parties and their
subcontractors may not deny the benefits of this Agreement to any person on the basis of
religion, color, ethnic group identification, sex, age, physical or mental disability, nor may
they discriminate unlawfully against any employee or applicant for employment because of
race, religion, color, national origin, ancestry, physical handicap, mental disability, medical
condition, marital status, age (over 40) or sex. The parties will insure that the evaluation and
treatment of students are free of such discrimination.
M. Entire Agreement. This Agreement constitutes the entire agreement and understanding
of the parties with respect to the subject matter hereof and supersedes all prior agreements,
arrangements, and understandings with respect thereto. No representation, promise,
inducement, or statement of intention has been made by any party that is not embodied
herein, and no party is bound by or liable for any alleged representation, promise,
inducement, or statement not set forth herein.
N. Notices. Any and all notices required or permitted by this Agreement shall be deemed to
have been duly given if written and mailed by United States registered or certified mail and
addressed as follows:
UNIVERSITY: INTERNSHIP SITE:
(Name of Faculty Advisor/Sponsor) (Full Name of Internship Site Contact)
California State University Channel Islands
One University Drive (Address of Internship Site)
Camarillo CA 93012
Phone: Phone:
(Advisor/Sponsor Phone) (Site Contact Phone)
Student’s Self-Procured Internship for Academic Credit
Page 6 of 7
O. Student Healthcare. If required, student will provide Internship Site with evidence of
adequate healthcare insurance coverage prior to commencement of the student’s work at
Internship Site.
P. First Aid. Internship Site will provide reasonable first aid in the event of an injury, but in
no circumstances shall Internship Site be financially or otherwise responsible for medical
care or treatment. Student is encouraged by the University to obtain personal health care
coverage.
Q. Access and Compliance to Policies and Procedures. Internship Site will provide access
to student all applicable Internship Site policies and procedures, rules and regulations.
R. Dissemination of Information. University will not, without Internship Site’s prior
written consent, publish or otherwise disseminate any documents, advertising, promotion,
report, article, research piece or any information which mentions or otherwise reasonably
identifies Internship Site or which uses any language from which a relationship between
Internship Site and University may, in the reasonable judgment of Internship Site, be
inferred.
S. Removal of Students. Internship Site shall have the right to refuse to permit any students
to participate in the internship at any time, with or without cause. Internship Site shall notify
University and University shall immediately remove form Internship Site any student who, in
the judgment of Internship Site, is not satisfactorily meeting the requirements of the
internship by, for example, failing to comply with relevant Internship Site policies, being
disruptive of Internship Site operations, or posing a danger or potential danger to the health,
safety, ore well-being of Internship Site personnel, clients, customers, patients, prospective
patients, employees or other individuals. Student is not an Internship Site employee and
therefore, none of the grievance procedures applicable to employees of the Internship Site
shall be applicable to student whose participation in an internship position has been
discontinued.
T. Students in Good Standing. Student participating in the internship must at all times
remain a student in good standing of University. University and Internship Site agree that
student is present at Internship Site to participate in activities and assignments that are of
educational value to student.
U. Debarment. University certifies to Internship Site under penalty of perjury, that
University has not been convicted of a criminal offense related to health care and is not
currently debarred, excluded or otherwise ineligible for participation in federally funded
programs. Further, University certifies that it does not currently, and will not at any time
during the term of this agreement, employ or subcontract any of University’s obligations
under this Agreement to any individual or entity that is debarred, excluded or otherwise
ineligible for participation in federally funded programs. University agrees to notify
Internship Site in writing immediately of any threatened, proposed or actual conviction
relating to health care, or any threatened, proposed or actual debarment or exclusion from
Student’s Self-Procured Internship for Academic Credit
Page 7 of 7
participation in federally funded programs. Any breach of this section of the Agreement by
University shall be grounds for immediate termination of this Agreement by Internship Site.
IN WITNESS WHEREOF, this Agreement has been executed by the parties as of the date
written above.
CALIFORNIA STATE UNIVERSITY
CHANNEL ISLANDS
(FULL name of Internship Site)
By: By:
Procurement & Contract Services Authorized Signatory
Printed Name & Title Printed Name & Title
Date Date
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Completed 14 March 2020

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