Career Services
University of Colorado Boulder
Boulder, Colorado 80309
T 303 492 6541
F 303 492 5723
Internship Learning Plan (Non-Credit)
for University of Colorado Boulder Internships
This agreement must be completed, signed and returned to Career Services in order for the internship to be
sponsored by the University of Colorado Boulder. This sponsorship includes Workers' Compensation insurance
coverage by the University of Colorado for non-paid internships.
Completion of this agreement is also necessary to ensure a high quality experience and satisfaction among all
parties. Make sure that you read the responsibilities under this agreement at the end of the Internship Learning
Plan, print everything out, obtain the required signatures and return the form to Career Services.
____________________________________________________________________________________________
Student Information
First Name: ________________ Last Name: ________________ Student ID: ________________
Email: ________________
Phone: ________________
Address: ________________________ City: _______________
Class Standing:
State: _______ Zip: _________
College/School:
Major: __________________________ Degree:
Graduation:
Employer Information
Employer Name: ________________________
Supervisor: ________________________
Email: ________________________
Phone: ________________________
Address: ________________________ City: _______________
State: _______ Zip: _________
Internship Information
Position Title: ________________________
Start Date:
End Date
This internship is (select one)
Voluntary
Paid
If paid, salary (per hour):
Hours per week: ____________ Total Hours: ____________
Descriptions:
Describe the nature of your position:
What do you hope to learn from this experience?
How are you going to accomplish your educational objectives? Discuss projects, readings, writings,
etc.
How will you evaluate the learning experience? What evidence will you provide to document your
accomplishments?
How often will you be evaluated by your supervisor? Monthly
By what method:
Weekly
Other
Responsibilities Under This Agreement
When signing this agreement, you agree to assume the responsibilities
listed for your role.
I, the Internship student, agree to:
1. Perform to the best of my ability those tasks assigned by my supervisor, which are related to my learning
objectives and the responsibilities of this position. 2. Follow all the rules, regulations, and normal requirements of
the employer's organization. 3. Notify Career Services of any changes I need to make in this plan or of any
problems that develop during the placement. 4. Complete an evaluation of the internship.
I, the Employment Supervisor, agree to:
1. Provide the necessary orientation, training, precautionary safety instructions, and supervision in the performance
of the position duties and responsibilities as listed above. 2. Understand the responsibility for providing Workers'
Compensation and liability insurance in accordance with Colorado state law, and agree to provide said coverage if
student is paid. 3. Complete a final written evaluation of the student's performance during the placement.
I, the University Internship Development Specialist, agree to:
1. Act as a liaison between the student and the employing organization. 2. Assist the student and employment
supervisor in resolving any problems or difficulties, which may arise. 3. Help students to write plans that specify
measurable learning objectives when requested.
According to C.R.S. 8-41-105 (7)(a) & (b):
The employer is responsible for providing Workers' Compensation and liability insurance coverage for those
students receiving remuneration for a student internship work experience. In cases where the student is not
receiving any remuneration for the work experience from the employer, the educational institution sponsoring the
student is responsible for providing Workers' Compensation.
The University of Colorado at Boulder encourages employers to extend Workers' Compensation coverage to all
students, whether paid or non-paid, since the employer can best control the safety of the work place and provide
accordingly for the risks a student may incur.
The student, employer, Internship Development Specialist agrees to assume these responsibilities for the duration
of the student's placement. The Internship Learning Plan must be completed in order for Career Services to endorse
the student's placement, and for the placement to be considered "sponsored" by the University of Colorado at
Boulder.
Please secure signatures in sequence.
Your signature means that you have read and agreed to this
plan.
Student _________________________________________ Date ___________
Work Supervisor __________________________________ Date ___________
Career Services Counselor __________________________ Date ___________