Fillable UpdatedWUInternshipAgreementForm10-24-18 Internship Contract

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UpdatedWUInternshipAgreementForm10-24-18 Internship Contract

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1
THE LANGUAGE IN THIS DOCUMENT DOES NOT CREATE AN EMPLOYMENT CONTRACT, EITHER EXPRESSED
OR IMPLIED, OR OTHERWISE ALTER THE AT-WILL EMPLOYMENT RELATIONSHIP BETWEEN ANY EMPLOYEE
AND WINTHROP UNIVERSITY. WINTHROP UNIVERSITY RESERVES THE RIGHT TO REVISE THE CONTENTS OF
THIS DOCUMENT, IN WHOLE OR IN PART, AS NECESSARY.
Human Development & Family Studies Internship Agreement
Winthrop University
Student Information (To be completed by the Intern)
Today’s Date:_____________ Number of Credits:__ Credit(s)
Class Enrolled In:___________ Semester/Year Enrolled: _________
__________________________________________________ _____________________________ @winthrop.edu
Intern Name (Print Clearly) Email (Winthrop email will be primary method of communication)
_________________________ ______________________
Phone Number Student ID #
_________________________ _____________________
Major Minor Concentration
____________________________
Class/Graduation Year
___________________________
Faculty Internship Coordinator
Are you legally authorized to hold a paid off-campus internship in the U.S.? Yes ☐ No ☐
Internship Site Information (To be completed by Internship Site Supervisor) For Profit ☐ Not for Profit ☐
_________________________________________________ ___________________________ ____________________
Organization Name Business License # or FEIN # State Issued
(do not provide a SS#)
___________________________________________________
________________________________________________
Name of Internship Site Supervisor/Degree in Human Sciences
(e.g., BA, BS, MA, MS, MEd, PhD, etc.)
Supervisor’s Title
___________________________________________________________________________ Available for site visit? Yes ☐ No ☐
Physical Address
________________________________________________
Supervisor's Phone
Internship Projected Start Date: _________
___________________________________________________
Supervisor's Email
Internship Projected End Date: __________
Est. Total Number of Weeks: ___________ Est. Total Hours/Week: ____________
Paid: Yes ☐ No ☐ If yes, $_______/________
Additional Compensation/Stipend: ________________________________________________________________________________
Internship site/supervisor accepts sole responsibility for determining the existence of an employment relationship as described by the
Fair Labor Standards Act (FLSA) Field Operations Handbook and for compliance with the FLSA and other state and federal wage-
related laws and regulations.
For Office use only:
Date Received ________ Correspondence site supervisor ☐ Correspondence sent to student ☐
Est. Mid-Point _________________
Other: _____________________________________________________________________________________________________
2
LEARNING AGREEMENT: Internship Job Description (To be completed by Internship Supervisor)
Attach a separate sheet for an actual job description if available. The job description is to be determined by the
Internship Supervisor, and approved by the faculty internship supervisor. The Internship Site Supervisor should
use the space below to describe the tasks, projects and learning outcomes for the intern in as much detail as
possible. This will serve as the written agreement between all parties involved. Internship Agreement and
Learning Agreement are not valid until approved by all parties.
Intern's Role/Tasks:
Specific Direct Service Projects Intern Will Work On/Assist With:
Learning Outcomes for Intern as They Relate to the Family Life Education Content Areas:
Additional Comments Regarding Internship:
I have read the internship agreement and learning agreement and will fulfill the duties and responsibilities of the student/intern
outlined for the internship and the academic requirements for completing the internship course for credit.
________________________________________________________________ ___________________
Intern’s Signature Date
I approve of and agree to the Internship Agreement, Learning Agreement, and responsibilities of the internship site supervisor. I
agree to abide by all the Equal Opportunity/Affirmative Action and other related federal and state laws and regulations in the hiring
of Winthrop University
students. I agree that the company will instruct/orient the student on company policies/procedures, and
provide a
safe working environment.
__________________
_______________________________________________________________
Internship Site Supervisor’s Signature
Date
3
PERSONAL LEARNING GOALS (To be completed by the intern)
Answer the following questions to complete your internship application for your particular site. These
answers in addition to your Learning Agreement must be reviewed and approved by the faculty internship
supervisor. Once the
Internship Agreement is completed and approved, bring it to the faculty internship
supervisor's office to finalize your internship.
1. Explain how this internship will add to your educational experience at Winthrop University. Be sure to
include how the internship will contribute to your application of and experience in at least one of the Family
Life Education content areas.
2. What professional and per
sonal goals do you hope to achieve while at this internship? (Be specific)
Listed below are specific assignments that will be required of all students completing an internship in order to satisfactorily
complete the experience and receive academic credit.
Course
Requirements
1. Submit internship agreement form
2. Submit resume
3. Attend four mandatory virtual meetings
4. Submit Family Life Education project plan
5. Submit weekly reflective journal entries online
6. Submit weekly time sheets signed by internship site supervisor online
7. Submit mid-point report
8. Receive mid-point evaluation from internship site supervisor
9. Submit internship final report including family life education project
10. Participate in an on site visit from the faculty internship supervisor
11. Create and deliver a poster presentation on the family life education
project
12. Submit final evaluation of internship site
13. Receive final evaluation from internship site supervisor
I approve of the Internship Agreement and Learning Agreement. The internship agreement and learning
agreement are valid for course credit.
___________________________________________________________
Winthrop Faculty Member Supervisor Signature / Date
4
General Res
ponsibilities of the Parties:
1. Student responsibilities:
a. Work on the days & times agreed upon with internship site supervisor
b. Dress in the appropriate attire for the internship site
c. Watch the CCE orientation video at www.youtube.com/watch?v=W2XIz-1-_cw&feature=youtu.be
d. Your safety is important. If you ever feel unsafe, harassed, or discriminated against at the site you
may leave on your own free will. The student should contact the internship coordinator and/or site
supervisor with concerns even if you are not sure.
e. Complete tasks and projects associated with the learning outcomes and family life education project
f. Complete all assignments
g. Communicate with all parties if length of the internship needs to be adjusted in order to complete the
hours requirement
h. DISCLAIMER:
Please note that the presence of job announcements on any website, list serve, bulletin or other
communications maintained by Winthrop University does not indicate an endorsement or
recommendation by Winthrop University or CCE. We are not responsible for safety, wages, working
conditions or other aspects of off-campus employment. We do not conduct a background check on
employers - so make sure you spend time researching before you apply.
2. Faculty Internship Supervisor or Designee responsibilities:
a. Meet with the student interested in an internship and discuss the internship requirements
b. Check with internship site supervisor to confirm the intern’s role
c. Send initial correspondence and follow-up emails at the mid-point and at the conclusion of the
internship
d. Be a sounding board and liaison for interns and site supervisors
e. Be vigilant! Listen for any safety and security concerns the students may have, and TAKE ACTION to
report or intervene if appropriate.
f. Make an on site visit during the internship
g. Assist the site supervisor and student with drafting the Family Life Education Project plan
3. Internship Site Supervisor responsibilities:
a. Follow the Fair Labor Standards Act for internships (www.dol.gov/whd/regs/compliance/whdfs71.htm)
b. Orient student/intern on the culture of the site and explain work place expectations to the intern
c. The safety of our students is of utmost importance. Students/interns are directed to report any safety
or workplace concerns to their faculty liaison or to Career and Civic Engagement. Internship
sites/supervisors are required to provide a safe environment and to abide by all federal and state
workplace laws and regulations in agreeing to accept an intern from Winthrop University into their
workplace.
d. Provide the student/intern and the Faculty Internship Supersvior or designee with any applicable
policies or procedures the student/intern is expected to follow.
e. Assign appropriate work projects that complement the learning objectives and collaborate with
student/intern on developing a Family Life Education project. Provide guidance on implementing the
Family Education project.
f. Complete the online mid-point and final evaluation of student and participate in an on site visit from the
faculty internship supervisor
h. Complete the online mid-point and final evaluation for the student
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UpdatedWUInternshipAgreementForm10-24-18 Internship Contract

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Completed 8 February 2020

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