Industrial Studies Internship

Approval and Work Agreement Form(v6FA)

STUDENT INFORMATIONSECTION

Student’s Full Name ______
Student’s PASS ID ______/ Student’s Advisor ______
Major ______/ Minor(s) ______
Emphasis: □BCM □BCSM □OSM □MTM □TE
Cell or land line where you can be reached ______/ UW-Platteville username ______

INTERNSHIP REQUIREMENTS

I have completed the following requirements for Industrial Studies Internship:

□ ENGLISH 1130 Freshman Composition / □ SPEECH 1010 Public Speaking
□ ENGLISH 1230 Freshman Composition / □ MATH (3 credits minimum Math 1530 or higher)
□ INDUSTDY 2710 Principles of Safety

My grade point average is ______for ______completed credits. Currently I am enrolled for ______credits. I understand that I must complete a minimum of 60 total credits before enrolling in Industrial Studies Internship. I must also have completed 15 credits (of the 60 total credits) of Industrial Studies courses to be eligible for internship.

WORK AGREEMENT SECTION

Contact Information during the Internship

Residence while
at work / Street ______
City______State _____ Zip ______
Cell or land line where you can be reached (if different than above): ______

Company Information

Company name______
Company address / Street: ______
City: ______State: _____ Zip: ______
Supervisor’s name: ______/ Supervisor’s phone number: ______
Supervisor’s email address: ______/ Supervisor’s cell phone #: ______
Starting date: ______/ Termination date: ______
Wages/salary: ______/ Working hours: ______
Facilities shut down or vacation will be: ______

Registration Information

Number of credits: _____ Type: ○Internship ○ First Half of Co-op ○ Second Half of Co-op
When are you doing the internship? Year ______Semester: ○ Fall ○Spring ○ Summer

Job Title:______

Job Description (Summarize the job responsibilities and tasks that you will be performing as an intern):

Give job title(s) and description for job you hope to have after graduating.

How will this job relate to both your degree program at UW-Platteville and your career goals and future employment? Don’t give general platitudes. Be specific.

I, the undersigned, agree to enroll and participate in Industrial Studies Internship in accordance with the regulations described in the Industrial Studies Internship Handbook. I understand that this Work Agreement is made between the Industrial Studies Internship Coordinator and myself for the internship experience described below as part of my degree program. I realize that university credit will only be given for satisfactory service to my employer and for the satisfactory completion of the academic requirements of the internship program. I will continue to work on this job until released or transferred by my employer and I will neither terminate nor arrange with my employer to be relieved of this job without the prior approval of the Industrial Studies Internship Coordinator.

(No signature required when submitted as PDF attachment email attachment. You must use your UWP email account.)

Student’s Signature ______Date ______

Advisor’s Signature ______Date ______

Directions

  1. Use your given name—not your nickname.
  2. You can find your PASS ID # at the top of your unofficial transcript.
  3. This form must be completed and then emailed along with a copy of your resume to your advisor for their approval.
  4. Once the internship has been approved you will need to upload this completed form to Desire2Learn.
  5. Signatures are not needed when submitting electronically.

Highlighted information must be complete and correct in order for intern/coop to be eligible for financial aid.