VOLUNTARY INTERNSHIP AGREEMENT
Solely for an unpaid internship
The faculty may require the internship to take place outside term time (see Art. 3 of this Agreement)
BETWEEN
1. The Université libre de Bruxelles, a university with legal personality under the law of 12 August 1911, amended by the Act of 28 May 1970 and the Decree of 31 March 2004, with its registered office at Av.50 Franklin Roosevelt, 1050 Brussels,
Represented by the academic supervisor responsible for the internship
Mr/Ms …..……………………….………………………………………………..………
2. The internship manager
Mr/Ms …..……………………….………………………………………………..………
Name of the organisation hosting the internship...... …......
Address: .....…......
Tel.:……………………………………..… Fax:………..……………………………
E-mail:….……………………………………………………………………………..
3.Mr/Ms
Student enrolled in...... ID. No......
Address....…...... …......
Tel.:……………………………………..… Fax:………..……………………………
E-mail:….……………………………………………………………………………..
Hereinafter referred to as "the voluntary trainee"
Article 1: Purpose of the Agreement
This Agreement governs the relations between the parties, as well as their respective rights and obligations in the context of a voluntary, unpaid internship directly related to the ...... course of study currently being followed at the ULB Faculty of ......
Article 2: Status of the voluntary trainee
The main purpose of the internship is to practically apply the theoretical teaching provided by the ULB and to round off the professional training of the voluntary trainee.
The internship is organised by the internship manager in consultation with the academic supervisor. In no case may the internship manager assign the voluntary trainee tasks unrelated to his/her training.
The internship will take place from ...... until ......
full-time part-time
Working days and hours:…………………………………………………..
Address at which the internship will take place (when different to that specified in Article 1): …………..…………………………………………………………………………………….....
The student trainee must be enrolled at the ULB
For the duration of the internship and within the limits of the current academic year, the student's enrolment at the Université libre de Bruxelleshas the following effect: the trainee maintains his/her student status
Article 3: Period
The voluntary internship may take place during term time / may only take place outside term time (i.e. at weekends, during public holidays when university activities are suspended, or during school holidays).
Article 4: Obligations of the voluntary trainee
During his/her internship, the trainee must abide to the internal rules of the host organisation and must comply with the instructions regarding the organisation of the internship given by those in charge of it.
Sick leave must be backed up by a doctor's certificate.
The trainee undertakes not to keep in his/her possession, to take away or copy any document, whatever its nature, belonging to the host organisation without the explicit consent of a representative thereof. The University undertakes that its staff will respect the confidentiality of any information it may become aware of through the internship completed by the trainee.
Article 5: risk assessment
In application of the Royal Decree (AR) of 21 September 2004 on the protection of trainees on work placements (amended by the AR of 30/09/2005) and in accordance with said decree, the Host Institution declares that the trainee need not be subjected to health monitoring when considered as not being exposed to any risk, insofar as the trainee has had a school medical check-up within the last five years: YES - NO ([[]1])
Should a risk exist necessitating health monitoring under the terms of the law, the Institution would like to ([[]2])
a) perform itself the health monitoring associated with the trainee's activities;
b) make use of the free service offered by the ULB-Erasmus-Bordet Joint Prevention and Work Protection Department (Service Commun de Prévention et de Protection au Travail) to monitor the trainee's health.
For this purpose, the Institution shall provide the “Application form: trainee health monitoring” (see Annex 1) AND a document compiled by the host institution describing the risks assessed at the trainee’s workplace. This document must cover:
a description of the workplace,
the preventive measures to be applied
the necessity for health monitoring
mandatory examinations and/or vaccinations
measures with regard to maternity protection
the contact data of the prevention counsellor - company doctor at the place of work.
The trainee, once he/she has these TWO documents, must ring up the ULB-Erasmus Occupational Medicine Department (Tel. 02 555 37 80) for an appointment. The actual check-up takes place either at Solbosch or Erasmus. Whatever the case, the conclusion of the health monitoring examination is specified on the health assessment form (see Annex 1) and handed back to the trainee (with a copy sent to the Faculty)
Article 6: Termination.
In the case of any party not respecting its obligations, each other party may terminate the Agreement after formal notice has been given to the party at fault and when this has not been acted upon within 8 days.
This includes any case of misconduct on the part of the trainee, with the ULB reserving the right, theoretically, to impose disciplinary measures against him/her.
Article 7: Insurance / liability
In view of the fact that this Agreement refers to a voluntary internship, the academic supervisor of the internship is obliged to inform the ULB's insurance department of the conclusion of this Agreement.
1. Insurance against physical accidents and waiver*
For accidents on the way from his/her home to the internship workplace or vice-versa, the student is covered by ETHIAS insurance policy 45.045.747, and for accidents at the internship workplace by ETHIAS insurance policy 65.695.22.
In the case of an accident, those in charge of the internship undertake to immediately inform the ULB, in the person of the academic supervisor, and to have the accident confirmed by a doctor.
The trainee needs to send the ULB's Insurance Department an accident report, using the form available on:
When the accident occurs while the student is relocating from home to the internship location or vice-versa, the student should use the following form: form:
2. Personal liability insurance and waiver*
The ULB has taken out a policy with ETHIAS (policy no. 45.072.897) covering its students' personal liability. This covers trainees during the internship but not on the way to/from work. Not included in this insurance is any damage to the trainee's personal effects.
It is agreed that in the context of internships organised by the University, the personal liability insurance also covers the trainee's internship supervisor, designated as such. This extension of coverage only applies in cases of shortcomings or after all other insurance policies covering the internship supervisor (in particular covering professional liability) have been used.
* Items 1 & 2 - Ethias waives its right of recourse against the management
and staff of the organisation where the internship takes place, except in cases of malicious intent.
3 Insurance package covering risks abroad (illness - accidents - repatriation)
For internships abroad, ULB students are covered under the provisions of ETHIAS policy no. 45.084.129 - tel.:24/7 - ETHIAS insurance company: tel.: 00/32.4.220.30.40 – E-mail:
Article 8: disputes and special provisions
Any dispute relating to this Agreement comes under the jurisdiction of the Brussels courts.
Any special provision is to be annexed to this Agreement and countersigned by the parties.
Should any such special provision contradict the terms of this Agreement, the provisions set forth in the latter shall take precedence.
For this Agreement to take effect, the trainee needs to forward to the academic supervisor responsible for the internship the document, duly completed and signed in three original copies. Two copies signed by the academic supervisor will be sent back to the student.
Signed in Brussels, on ...... , in triplicate, with each party acknowledging receipt of his/her copy.
M.C. Mis à jour le 05/11/20131/5
The voluntary trainee
(Signature)
The internship manager
(Signature)
For the university, the academic supervisor responsible for the internship
(Signature)
M.C. Mis à jour le 05/11/20131/5
[[][1] Cross out where not applicable
[[][2] Cross out the option (a or b) not selected