UNIVERSITY OF MINNESOTA, DULUTH


UMD Department of Political Science                                                      Intern Contract Form


Name:

Date:

Internship Course:

Year in school:

Email address:

Student ID:

Phone:

Major(s):

Minor(s):

School Address:

Permanent Address:

Agency or Organization:

Address:

Work Supervisor:

Phone:

Academic Supervisor:

Phone:


WORK COMPONENT


Nature of tasks performed by the intern:

What will the intern learn from these tasks?

Dates of employment:

Number of hours per week:

Days and hours scheduled:

Wages, if any:

The above agreement has been mutually agreed upon by the intern and work supervisor. The work supervisor agrees to provide the intern with an orientation concerning relevant organizational arrangements, procedures, and functions. Moreover, s/he will meet with the intern regularly and will be available for counsel and advice for the duration of the internship. The intern agrees to complete all work assignments promptly and to the best of his/her abilities. In addition, the intern accepts the obligation of confidentiality in his/her work and relationship with the work supervisor and agrees to familiarize himself/herself with and adhere to the appropriate standards of ethical conduct.


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ACADEMIC COMPONENT


Session registered for: ❒Fall ❒Spring ❒Summer

Number of Credits:

List the academic objectives of the internship that have been mutually agreed upon by the academic supervisor and the intern:

Indicate the academic activities that the intern will be engaged in concurrently with the work experience:

What will be the basis for evaluation and/or the assignment of a grade?

The intern and academic supervisor will meet periodically during the semester/session, or as outlined below, to discuss the internship experience and to assess the achievement of academic objectives.

When all parties are in agreement with this contract, they should indicate their approval by signing below.



The above agreement has been mutually agreed upon by the intern and the academic supervisor.



Intern:              

                     signed                                                                                                                                                       date


Work Supervisor:  

                                                signed                                                                                                                                  date


Academic Supervisor:             

                                                         signed                                                                                                                       date


Upon completion of this contract, turn it in to the Political Science Dept. Office, 304 Cina Hall. The original will be retained by the academic supervisor; a copy will be retained in the Dept. Office; and copies will be sent to the work supervisor and the intern.

April 9, 2003