Non-Credit, Leadership RAP Internship Contract
 CHANCELLOR’S LEADERSHIP STUDIES PROGRAM
 ETHNIC LIVING AND LEARNING COMMUNITY LEADERSHIP STUDIES
PROGRAM
The purpose of this agreement is for you, your instructor (the Leadership RAP Director) and your
internship supervisor to outline the goals, activities, and learning objectives for your non-credit
internship through the Leadership RAP to fulfill the requirement for the Certificate in the Study
and Practice of Leadership. Please be as explicit as possible when completing the following
agreement. Be sure your supervisor keeps a completed and signed copy. Keep one copy for
yourself and return the original copy to the instructor.
CONTACT INFORMATION
Student name_________________________________
SID#__________________
E-mail ______________________________________ Phone #___________________
Organization ___________________________________________________________
Supervisor Name________________________________________________________
E-mail______________________________________Phone# ____________________
Instructor name: Ann Scarritt
E-mail: Ann.Scarritt@colorado.edu
Leadership RAP
406 UCB
University of Colorado
Boulder, Colorado 80309
Phone#: (303) 735-0373
Fax: (303) 735-2682
INTERNSHIP
What is the organization’s mission? (provide source citation)
Position Description
Describe in detail your internship roles and responsibilities.
Supervision
a) Describe the supervision that you will receive at the organization.
b) What will be the method of evaluation?
Minimum number of hours that you have agreed to complete: 144.
Start date____/___/____
End Date____/____/____
Responsibilities Under This Agreement
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 the rules, regulations and requirements of the employer’s organization.
3. Complete all required assignments and consult as needed with my instructor for
guidance and feedback.
4. Notify my instructor of any changes I need to make in this agreement or of any
problems that develop during the placement.
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 on this
agreement.
2. Complete both a mid-term and final written evaluation of the student’s
performance during the placement and send it to the instructor listed on this
application.
I, the Instructor agree to:
1. Attest that the proposed internship is relevant to the study and practice of
leadership and the student’s area of interest.
2. Agree to monitor, and evaluate the internship as appropriate.
3. Agree to insure that the evidence needed to document the students learning
experience for the purposes of fulfilling the internship requirement of the
Certificate for the Study and Practice of Leadership is appropriate, completed, and
submitted in a timely fashion before the certificate is awarded.
Agreement
By signing this form, you agree to the conditions stated above.
Student signature_________________________________ Date________
Instructor’s signature______________________________ Date________
Supervisor’s signature_____________________________ Date________
Updated 1/2015