The following employer (“Employer”) agrees to provide an internship to the student (“Student”) according to the provisions below. It is understood that the internship is limited to the student identified below, is intended to cover the period of time indicated below, and will consist of the supervised work and learning experiences identified below. Internships are either operational (the intern spends time in a number of departments) or project-oriented (the intern focuses on a limited number of departments or projects). In every case it is expected that the intern will complete special projects and also contribute to the operation while benefiting from the learning and work experience.

Student Name:
Address:
Phone:
Email:
Faculty Supervisor or Course Instructor:
If the internship is required for course credit:
Course name:
Instructor (if different from above):
Requirements in terms of hours, expectations, skills to be acquired, etc.:
Work experience:
Volunteer experience:
Special skills:

Employer Name:
Address:
Site Supervisor & Title:
Intern Position:
Phone:
Email:
Department:

Estimated Number of Hours for the Internship:
Start Date:
End Date:

Learning Outcomes: What are the learning outcomes of this internship? What do you want to learn as a result of this internship?

Internship Responsibilities: Identify and describe the nature of the service activities in which you will be engaged. The internship responsibilities should be designed to help you achieve your learning outcomes.

THE SITE SUPERVISOR (EMPLOYER REPRESENTATIVE):

As an authorized agent and acting on behalf of the Employer indicated on Page 1 of this Agreement, the Employer agrees to the following:

  1. Guide the student’s work and submit performance evaluations of his/her achievement on a monthly basis or frequency agreed upon by Employer and Student.
  2. Discuss any concerns about the student’s performance with him/her directly, and with the faculty supervisor as necessary.
  3. Comply with criteria established by the U.S. Department of Labor and the California Department of Labor for all unpaid internships.
  4. Agree to assignment scope and duration as defined above.
  5. Accept only interns who are 18 years or older.
  6. Provide a general work site orientation and supervision and to make every reasonable effort to provide a safe working environment.
  7. If required by the educational institution we agree to certify that the student completed the minimum hours of service required by this service learning or academic internship course.

My signature below indicates I have thoroughly reviewed the information contained in this document and agree to the terms for a short-term relationship between the Employer and Monterey Bay Internships.

Employer Signature:
Date:

(Note to Site Supervisor: If you are aware of any risk factors present at this Organization, it is imperative to list them here.)

STUDENT:

The Student agrees to abide by the following Guidelines and Limitations:
Guidelines:

  • DO ask for help when in doubt: Your site supervisor understands the issues at your site and you are encouraged to approach him/her with problems or questions as they arise. He/She can assist you in determining the best way to respond to difficult or uncomfortable situations. Feel free to contact your professor or faculty supervisor with questions concerning your placement.
  • DO make sure you are punctual and responsible: While you are an intern, you are participating in the organization as a reliable, trustworthy and contributing member of the team. Both the administrators and the person(s) whom you serve rely on your punctuality and commitment to completing your service hours/ project throughout your partnership.
  • DO call if you anticipate lateness or absence: Call the Site Supervisor if you are unable to come in or if you anticipate being late. Be mindful of your commitment; people are counting on you.
  • DO respect the privacy of all clients: If you are privy to confidential information with regard to the person(s) with whom you are working (i.e. organizational files, diagnostics, personal stories, etc.), it is vital that you treat it as privileged information. You should use pseudonyms in your course assignments if you are referring to clients or the people you work with at the service site.
  • DO act appropriately: You are in a work situation and are expected to treat your Site Supervisor and others with courtesy and kindness. Dress neatly and appropriately. Use formal names unless instructed otherwise. Set a positive standard for other students to follow.
  • DO show flexibility: The level or intensity of activity at a service site is not always predictable. Your flexibility to changing situations can assist the partnership in working smoothly and producing positive outcomes for everyone involved.

Limitations:

  • DON’T report to your service site under the influence of drugs or alcohol.
  • DON’T give or loan a client money or other personal belongings.
  • DON’T make promises or commitments to a client you cannot keep.
  • DON’T give a client or agency representative a ride in a personal vehicle.
  • DON’T tolerate verbal exchange of a sexual nature or engage in behavior that might be perceived as sexual with a client or community partner representative.
  • DON’T tolerate verbal exchange or engage in behavior that might be perceived as discriminating against an individual on the basis of their age, race, gender, sexual orientation, ability, or ethnicity.
  • DON’T engage in any type of business with clients during the term of your service.
  • DON’T enter into a personal relationship with a client or community partner representative during the term of your service.

 

*If you feel that your rights have been or may be violated, or that any of the above stated limitations have been violated, please immediately contact the Site Supervisor and Faculty Supervisor/Course Instructor.

FACULTY / COURSE SUPERVISOR:

I, (Faculty/Course Supervisor Name ___________________________), acknowledge I have examined and approve this Placement Agreement and its Learning Outcomes and Internship Responsibilities.

 

Signature: _________________________________ Date:___________

 

EMPLOYER ACKNOWLEDGEMENT:

I, (Employer Representative ___________________________), understand and acknowledge the risks involved with this student placement, and enter into this intern placement fully informed and aware.

 

Signature: _________________________________ Date:___________

STUDENT ACKNOWLEDGEMENT:

I understand that the Employer discretion may require me to sign a nondisclosure, noncompete or nonsolicitation agreement. These agreements are under the purview of the employer’s legal department and are designed to protect the employer’s business interests.

I agree to the assignment scope and duration defined above.

I acknowledge that I am 18 years or older.

I will act in a responsible manner at the internship site, and abide by all the rules and regulations that govern the site in which I have been placed.

I understand the connection between the academic internship course and the Learning Outcomes to be fulfilled at this internship site.

I will participate in an orientation if required by the Employer prior to any internship activities.

I have read the above stated Guidelines and Limitations and understand my role as a student intern in working with the Employer.

I agree to complete any forms, evaluations or other paperwork required by either the course, Faculty member or the Site Supervisor.

I have read and understand the entire Learning Outcomes and Internship Responsibilities sections.

I, (Student Name _____________________________________), agree to the terms above and agree to comply with the guidelines.

Signature: _________________________________ Date:___________

Download Sample Agreement