International Programs Office
International Internship Sponsor Questionnaire
SUNY Cortland Intern Name:
Host Agency/Organization Name:
Host Agency Address:
Host Agency Phone and Fax numbers:
Host Agency Contact Person:
Contact Person E-mail Address:
Site Supervisor Contact Information:
Person Designated to Assist the Intern in the event of an Emergency:
Date student should arrive:
Date student should depart:
Airport into which student should fly:
Where should the student report upon arrival?
Please describe how the student will get from the airport to the location listed in the previous
question? Will there be a cost involved and if so, what is that cost?
Where will the intern be housed? Please include the address and a description of the location,
including verification of safety and security measures such as locks, smoke alarms, etc.
How far away from your location are the nearest medical facilities? Can you describe them
briefly?
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Does your site offer liability insurance or will our student be required to purchase additional
coverage through your agency prior to arrival? If there is a cost involved, please note it below.
Is it possible for our student to purchase local health insurance? If so, are you able to offer any
details regarding cost and how the student would enroll?
Please describe the tasks, project(s) that will be assigned to the intern.
What are the start and end dates of the internship?
How many hours per week with the intern be working on-site? (Our interns earn one credit for
every 40 hours on-site).
How will the intern be supervised? Will the site supervisor be working with the intern on a daily
basis or just checking in periodically?
What are your procedures for assessing the intern and for documenting that assessment?
Will the intern have to apply for a special work permit or visa? If so, please give details below.
Does your organization/agency offer any type of orientation upon arrival? Please describe it
briefly below or attach a copy of the orientation schedule.
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Does your organization/agency offer any type of training sessions that outlines your procedures,
expectations, rules and regulations? Please describe them.
Has your agency hosted interns in the past? If so, approximately how many?
Does your organization/agency belong to any professional organizations or hold any professional
licenses/certifications/registrations, etc?
Please list below any fees for the internship experience, what they are for, when they are due,
and the refund policy.
Are there any health or safety issues about which we should be aware with regard to the location
of this is internship or the tasks that will be expected of this intern? If so, please describe them
below.
Please feel free to comment or ask questions below. We will be happy to reply to you as quickly
as we can.
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The information on this form is true to the best of my knowledge.
_____________________________________
Internship Provider’s Signature
___________________________
Date
Please sign and return this questionnaire as soon as possible, preferably by fax or e-mail, to the
following:
SUNY Cortland
International Programs Office
PO Box 2000
Cortland, NY 13045 USA
Phone: 607-753-2209 Fax: 753-5989
E-mail: gonda.gebhardt@cortland.edu
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