ITHACA COLLEGE
INTERNSHIP AGREEMENT
Student Name
Site Name and Location
Dates of Placement
Description of Field Experience
The student shall, at all times, be subject to and comply with all rules, regulations, procedures, and
policies of Ithaca College and the Site.
Ithaca College students will be covered by the College’s general liability insurance and the College will
provide certificate of said coverage to the Site upon request.
The Site shall provide appropriate supervision of student by appropriate, qualified personnel, make
available the relevant facilities for student training, including necessary and appropriate equipment and
supplies, and shall undertake such activities as will permit student to gain field experience.
The parties acknowledge that some student internship records could be considered educational records
protected by the Family Educational Rights and Privacy Act (FERPA), and that student permission must
be obtained before releasing specific student information to anyone other than Ithaca College.
While participating in the field experience, the student shall in no event become nor be deemed to be
employees, servants or agents of the Site, nor shall any person on the staff or administration of the Site
become or be deemed to be an employee, servant or agent of the College.
Both parties agree to indemnify and hold free and harmless the other and its respective facilities, trustees,
directors, officers, agents, employees and appointees from expenses, claims, lawsuits and judgments for
which the indemnified party may become liable to pay or defend as a direct result of any negligent act or
omission on the part of the indemnifying party, its employees, agents, students, guests or appointees
which might arise as a direct result of Ithaca College’s student internships.
INTERNSHIP SITE
BY:
<NAME>
<TITLE>
Date:
ITHACA COLLEGE
BY:
<NAME>
<TITLE>
Last revised 5/3/2012
Date: