STUDENT PARTICIPATION AGREEMENT
WOMEN’S AND GENDER STUDIES PROGRAM
The primary reason for participating in an internship is to apply academic knowledge in a practical setting.
The University has an Agreement with the following organization as a host site for a student internship.
Work Site Name, Address, Contact Person, Telephone
Duration of Internship
From: ___________ to ________for ________ hours of academic credit
Brief Statement of Intern’s Learning Objectives as Related to the Internship:
Brief Description of Internship Duties:
Internship Policies:
The student agrees to arrange and adhere to a work schedule approved by the work site coordinator, and will
notify the Internship Coordinator of any change in enrollment status or circumstances that will prevent the
completion of the internship. The student agrees to: a) submit a bi-weekly written report summarizing his or
her internship hours to the supervising faculty member; b) contact the supervising faculty member at least
every two weeks to discuss internship progress; c) inform the work site supervisor and supervising faculty
member immediately if any problems develop that interfere with the intern’s work performance or learning
experience.
Evaluation
The work site supervisor will submit an evaluation of the student’s performance no later than the first day of
final examination for the semester, which will be due on ______________.
DATE
Insurance
The student acknowledges that his/her participation in this internship does not establish them as an
employee or agent of the University. The University is prohibited from accepting any liability for the acts,
omissions, and conduct of students participating in internships with host organizations, and is prohibited
from providing insurance coverage to the student.
Termination of Student Participation for Cause
The student agrees to comply with the work site’s administrative and operating policies, procedures, rules,
and regulations. The work site supervisor may request that the University withdraw from the program any
student who, in the work site supervisor’s judgment, is not performing satisfactorily, or who refuses to
follow the work site’s administrative and operating policies, procedures, rules, and regulations.
Discrimination
Neither the University nor the work site shall engage in discrimination in the treatment of any participant
connected with the internship. Discrimination means any act that unreasonably differentiates selections and
treatment, intended or unintended, based upon age, disability, national origin, race, marital status, religion,
sex, or sexual orientation. Student agrees to notify the Internship Coordinator of any treatment that the
student believes to constitute discrimination or sexual harassment.
By the signatures below, the parties acknowledge that they have read, understand, and agree to abide by the
terms of this agreement.
Student Signature
Student’s Printed Name
Date
Address
Telephone
Supervising Faculty Member
Date
Internship Coordinator
Date