Internship Learning Contract

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Internship Learning Contract

Contact Information

Student Name*

First Name

Last Name

Student ID*

Student Email*

Faculty Sponser*

First Name

Last Name

Faculty Sponser Email*

Advisor Name*

First Name

Last Name

Advisor Email*

Internship Information

Internship Placement*

Name of business.

Internship Address*

Address Line 1

Address Line 2

City

State

ZIP Code

Internship Job*

Start Date of Internship*

End Date of Internship*

Educational Goals*

Total # of Hours*

Number of Credits*

45 hours = 1 credit.

Site Supervisor Name*

First Name

Last Name

Site Supervisor Email*

Site Supervisor Phone*

Site Supervisor's Responsibilities *

Tracking time, providing written evaluation, how often, etc.

Site Supervisor Approval*

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Upload an email where the site supervisor approves the internship.

Routing Information

Approvals:

Faculty Sponsor (approval)
Advisor (approval)
Associate Dean (approval)

Processing:

Coordinator of Theatre Operations (course listing & registration)

Notifications:

Student
Faculty Sponsor
Career & Engagement Specialist

Faculty Sponsor Approval

Approval*

Yes No

I have discussed the equity issues around internships, pay and credit.*

Yes No

Comments

Site Supervisor Approval

Name*

First Name

Last Name

Phone

The student shall, at all times, be subject to and comply with all rules, regulations, procedures, and policies of Ithaca College and the Site.
The Site shall provide appropriate supervision of student by appropriate, qualified personnel, make available the relevant facilities for student training, including necessary and appropriate equipment and supplies, and shall undertake such activities as will permit student to gain field experience.
The parties acknowledge that some student internship records could be considered educational records protected by the Family Educational Rights and Privacy Act (FERPA), and that student permission must be obtained before releasing specific student information to anyone other than Ithaca College.
While participating in the field experience, the student shall in no event become nor be deemed to be employees, servants or agents of the Site, nor shall any person on the staff or administration of the Site become or be deemed to be an employee, servant or agent of the College.
Both parties agree to indemnify and hold free and harmless the other and its respective facilities, trustees, directors, officers, agents, employees and appointees from expenses, claims, lawsuits and judgments for which the indemnified party may become liable to pay or defend as a direct result of any negligent act or omission on the part of the indemnifying party, or its employees, which might arise as a direct result of Ithaca College’s student internships.

Signature*

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Advisor Approval

Approval*

Yes No

I have discussed the educational goals with the student.*

Yes No

Comments

ADean Approval

Approval*

Yes No

Comments

Coordinator of Theatre Operations

Course Created

Yes

Course #*