Faculty Mentoring Agreement Form
Student name
Student ID#
Proposed faculty mentor
Semester activity proposed Fall  Spring Summer  Year 20__
Class proposed
Completed coursework
before proposed start date:
SOCI 4950 
SOCI 4901  SOCI 4902  SOCI 4903
SOCI 1010  SOCI 2500  SOCI 2530  SOCI 2530L  SOCI 3030 
Class standing Junior 
Senior 
Other:
_______________
On back of this form or on an attached sheet, explain your plan for an internship or independent study.
Where do you plan to intern or what do you plan to do for an independent study? Be concrete and specific.
Why are you requesting to work with this particular faculty member?
Upon completing this form and discussing your plans with your adviser AND your proposed faculty mentor
(if different), gather signatures and submit to the proposed faculty mentor.

By signing below, you acknowledge that this form only gives you permission to proceed in making
plans to do an independent study or internship the following semester. The faculty mentor may
terminate this agreement in the event that you do not produce a proposal for a study or secure an
internship placement in a timely fashion.

Your signature below indicates that you have received and carefully reviewed the Guidelines and Policies
Governing Internships/Independent Study. Your mentor or placement site will likely impose additional
policies and regulations with which you must abide.
Follow the timelines and checklists provides in the Guidelines and Policies Governing Internships
/Independent Study to complete the process. A draft of an independent study proposals should be
submitted by mid-terms so that you may get feedback before the final proposal is due. For internships, you
should meet with career services and complete your resume by mid-terms. The next deadline is to
submit a complete proposal (November 20 or May 30).
_______________________ _________________________
_____________________
______
Signature of Student
Signature of department head
date
Signature of proposed faculty mentor
This completed form is due by September 15 for the spring and February 15 for fall
Copies of the form should be kept by student and faculty and a copy given to the dept. head.