Student Participation Agreement

STUDENT PARTICIPATION AGREEMENT WOMEN’S AND GENDER STUDIES PROGRAM

The primary reason for participating in an internship is to apply academic knowledge in a practical setting. The University has an Agreement with the following organization as a host site for a student internship.

Work Site Name, Address, Contact Person, Telephone

Duration of Internship From: ______to ______for ______hours of academic credit

Brief Statement of Intern’s Learning Objectives as Related to the Internship:

Brief Description of Internship Duties:

Internship Policies: The student agrees to arrange and adhere to a work schedule approved by the work site coordinator, and will notify the Internship Coordinator of any change in enrollment status or circumstances that will prevent the completion of the internship. The student agrees to: a) submit a bi-weekly written report summarizing his or her internship hours to the supervising faculty member; b) contact the supervising faculty member at least every two weeks to discuss internship progress; c) inform the work site supervisor and supervising faculty member immediately if any problems develop that interfere with the intern’s work performance or learning experience. Evaluation

The work site supervisor will submit an evaluation of the student’s performance no later than the first day of final examination for the semester, which will be due on ______. DATE

Insurance

The student acknowledges that his/her participation in this internship does not establish them as an employee or agent of the University. The University is prohibited from accepting any liability for the acts, omissions, and conduct of students participating in internships with host organizations, and is prohibited from providing insurance coverage to the student.

Termination of Student Participation for Cause

The student agrees to comply with the work site’s administrative and operating policies, procedures, rules, and regulations. The work site supervisor may request that the University withdraw from the program any student who, in the work site supervisor’s judgment, is not performing satisfactorily, or who refuses to follow the work site’s administrative and operating policies, procedures, rules, and regulations.

Discrimination

Neither the University nor the work site shall engage in discrimination in the treatment of any participant connected with the internship. Discrimination means any act that unreasonably differentiates selections and treatment, intended or unintended, based upon age, disability, national origin, race, marital status, religion, sex, or sexual orientation. Student agrees to notify the Internship Coordinator of any treatment that the student believes to constitute discrimination or sexual harassment.

By the signatures below, the parties acknowledge that they have read, understand, and agree to abide by the terms of this agreement.

Student Signature Date

Student’s Printed Name Address Telephone

Supervising Faculty Member Date

Internship Coordinator Date