Internship Agreement Form

Unity College Career Services Internship Program

Summer internships paperwork is due by the 1st Friday in April. An electronic copy of this agreement, your resume and job description is due at this time. Extensions may be requested by the 1st Friday in April. Extensions will be granted up to the 3rd Friday in May. Paperwork for summer internships will NOT be accepted after the 3rd Friday in May.

Hardcopy of signature pages should be delivered to Career Services. Internship agreement, resume and job description should be emailed to .

See Internship Handbook for semester and outside the semester internship deadlines.

Internship Information

Start Date: Click here to enter a date. / End Date: Click here to enter a date. / Total On-Site Work Hours:
Click here to enter text. / Semester: Choose an item.
Course Rubric Number and Title (pg. 4 in Handbook): Click here to enter text. / Academic Level: Choose an item. / Number of Credits: Click here to enter text.
Intern Position Title:
Click here to enter text. / Internship Site Name:
Click here to enter text.

Intern Information

First Name: Click here to enter text. / Last Name: Click here to enter text. / Expected Grad Date: Choose an item.
Primary Email Address:
Click here to enter text. / Secondary Email Address:
Click here to enter text.
Primary Phone Number (XXX-XXX-XXXX):
Click here to enter text. / Alternate Phone Number (XXX-XXX-XXXX):
Click here to enter text. / Degree Type: Choose an item.
Major: Choose an item. / Second Major: Choose an item.
Academic Advisor: Click here to enter text. / Academic Advisor Email: Click here to enter text.
Emergency Contact Name:
Click here to enter text. / Relationship: Click here to enter text. / Phone Number (XXX-XXX-XXXX):
Click here to enter text.

Faculty Mentor Information

Mentor Name: Click here to enter text. / Mentor Email: Click here to enter text.
Mentor Phone Number (xxx-xxx-xxxx):
Click here to enter text. / Mentor Emergency Phone Number (xxx-xxx-xxxx):
Click here to enter text.
Communication Plan: Click here to enter text.
(Describe how frequently and what method of communication ex: email, phone etc. that will be used to contact your Mentor. Interns must be in contact with Faculty Mentors bi-weekly.)

Internship Site Information

Internship Site Street Address:
Click here to enter text. / City: Click here to enter text. / State: Click here to enter text. / Zip: Click here to enter text. / Country: Click here to enter text.
Internship Site Mailing Address:
Click here to enter text. / City: Click here to enter text. / State: Click here to enter text. / Zip: Click here to enter text. / Country: Click here to enter text.
Supervisor First Name:
Click here to enter text. / Supervisor Last Name:
Click here to enter text. / Supervisor Title:
Click here to enter text.
Supervisor Phone Number (xxx-xxx-xxxx):
Click here to enter text. / Extension: Click here to enter text. / Supervisor Email:
Click here to enter text.
Website: Click here to enter text. / Compensation: Choose an item. / Rate of Pay: $Click here to enter text.
Non-Monetary Compensation: ☐Room ☐Board ☐Uniform ☐Travel Compensation ☐Training ☐Other (please specify):
NOTE: Non-monetary compensation may have tax implication. Please check with a tax professional for more information
Organization Mission Statement:Click here to enter text.
(Copy and paste the organizations mission statement here. Cite Source)
Intern Physical Address During Internship:
Click here to enter text. / Internet access during your internship? Choose an item.
Workman’s Comp and/or general liability? Choose an item.
Visit site prior to internship? Choose an item.

Long Term Career Goal

Click here to enter text.
(Describe your long term career goals and how this internship will help you prepare for these goals.)

Internship Summary of Duties

Click here to enter text.
(Using first person narrative, describe the nature of your position and anticipated duties as you perceive them after speaking to your supervisor. Include specific projects, tasks and duties of the position that are not necessarily listed in the job description provided to you by your employer.)

Academic Learning Objectives

1. Click here to enter text.
2. Click here to enter text.
3. Click here to enter text.
4. Click here to enter text.
5. Click here to enter text.
(In a numbered list format, identify 5 specific educational goals that you hope to fulfill by the end of the internship. Learning objectives should not try to cover all aspects of the internship, but focus on select areas that you will be exposed to throughout the internship. Each learning objective should involve new learning, expanded growth, or improvement on the job. Begin each object with words such as “Learn how to”, “Expand knowledge of”, “Better understand the process of”. Think of these objectives as an extension of your academic experience. If you are unsure of what an acceptable learning objective entails, speak to your faculty Mentor or see page 14 of the handbook)

Academic Prerequisites

Example: WF 2003 Animal Training
Click here to enter text.
(List academic courses and course rubrics. You may include volunteer experiences that have prepared you for this experience. Please note that all 3000 and 4000 level internships require 12 credits at or above the 2000 level.)

Internship Grade and Academic Requirements

1. Track and Complete Required Hours

2. Bi-weekly Check-in with your Faculty Mentor

  • Share one accomplishment you achieved since your last check-in. You may attach your journal entries.
  • Please explicitly state that things are either a) going well, no problems, or b) not going well, in which case clearly identify anything that may be troubling you and any questions you may have about the internship or internship process.

3. Internship Portfolio

  • Internship Agreement, Resume, Job description
  • Photo documentation (Please note: some sites have photo restrictions – check first)
  • Worksite Supervisor Evaluation (Note: you have the right to rebuttal a negative evaluation)
  • Final reflection paper addressing learning objectives
  • Internship Journal

(Please select one, see Internship Handbook for Specific Requirements)

☐Weekly Reflective Journal

☐Weekly Blog

4. Public Presentation (3000 and 4000 level internships).

Presentation Type (choose all that apply):Presentation Location (choose one):

☐Demonstration☐Public Forum

☐Video☐Open House

☐Talk☐Class

☐PowerPoint Presentation☐Club

☐Storyboard (tri-fold poster)☐Internship Showcase Event

☐Slides☐Student Conference

☐Other Click here to enter text.☐Other Click here to enter text.

Please include the following information regarding your presentation:

Name of Class: Click here to enter text.

Name of Class Professor: Click here to enter text.

Name of Club: Click here to enter text.

Name of Public Forum:Click here to enter text.

Date of Presentation: Click here to enter text.

***For 6, 9, or 12 credit internships please describe your project or report below***

Please describe your project ideas. This should be discussed with your faculty Mentor and sit supervisor prior to submitting your internship agreement form. Be sure to include the outcome and how the project will be assessed.

Final Due Date: Click here to enter a date.

Signatures (Required in Hardcopy Only)

I agree to serve as the faculty Mentor for this internship. I have reviewed this agreement form with the student and believe that it meets the standards described in the Internship Handbook. I have read and understand my responsibility as outlined in the handbook and will contact the site supervisor prior to the internship start date.

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Faculty Mentor PrintFaculty Mentor SignatureDate

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Intern has met with the Director of Student Accounts and understands the financial obligations he/she is undertaking when registering for this internship.

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Signature of Director of Student Accounts/ Unity College Business OfficeDate

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I agree by signing and submitting this internship agreement that I am committing to the college and my internship site the terms listed within the agreement. Furthermore I understand that I am responsible for:

•Finding, reviewing, and understanding the internship site location, position duties and housing accommodations

•Funding all travel expenses to and from the site location, as well as all expenses incurred during the internship

•Fulfilling all reasonable tasks and responsibilities assigned by my site supervisor

•Completing all the required hours according to my credit level requirements

•Following all internship site safety procedures and policies

•Conducting myself in an ethical and professional manner, acting as a positive representative of Unity College

•Notifying the Career Resource Center and Faculty Mentor immediately of any changes or problems during this Internship

•Completing the required academic work and public presentation before the final due date listed above

•Reporting to your Faculty Mentor as detailed in the agreement

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Student Signature Date

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Release, Covenant Not To Sue,

And Assumption of Risk Agreement

I, the undersigned Participant, for myself, my heirs, legal representatives and assigns, in consideration of permission granted to me by Unity College, located in Unity, Maine, to enroll in and to participate in a program offered by Unity College, entitled and scheduled as follows: Unity College Internship Program, which will take place during the 2017 and 2018 calendar years inclusive, hereby release, acquit and forever discharge Unity College, its Trustees, officers, employees and agents, both in their individual capacities and in their capacities as Trustees, officers, employees and agents of Unity College, their heirs, legal representatives, successors and assigns, from any and all claims, demands, actions or causes of action, of any kind whatsoever, including claims for contribution and/or indemnification, arising out of my participation in said program.

I, also, for myself and for my heirs, legal representatives and assigns, for the same consideration, covenant with Unity College, its Trustees, officers, employees and agents, both in their individual capacities and in their capacities as Trustees, officers, employees and agents of Unity College, their heirs, legal representatives, successors and assigns, never to institute any suit or action at law or in equity against them, or any of them, whether or not the result of their negligence, by reason of any claim I now have or may hereafter acquire relating to said program and/or my participation in said program.

I assume the risk of any injuries which I may receive as a result of my participation in said program, whether or not the result of their negligence.

I also certify that the information I have provided to Unity College in the registration packet accompanying this release, covenant not to sue, and assumption of risk agreement, is true and accurate and recognize that any false or incorrect statements made therein are grounds for my dismissal from the program.

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Intern Name (Print or type)Intern Name (signature) Date