All Other Applications

Below is a list of information required for most internship applications at Penn State Altoona.

Student Information

Name:
PSU ID:
Major:
Semester/Year of Internship:
Course:
Number of Credits:
Phone:
Email:

Host Site Information

Organization:
Address:
Phone:
WWW:

Supervisor Information

Name:
Title:
Phone:
Email:

Faculty Information

Name:
Email:
Phone:

Internship Release

General Release

During the semester indicated, I will be performing my student internship for the course listed above.
I will be performing this internship to gain experience that will help me in my college education at Penn State Altoona. If this is an unpaid internship, I understand that no employer-employee relationship will exist between the supervising organization and me.
I will be performing this internship voluntarily and upon my own initiative, risk, and responsibility.

Personal Conduct

I understand that the responsibilities of an off-campus internship require a high standard of professionalism. Therefore, I indicate my willingness to conform to the professional standards of the internship host site as well as to the terms of the Penn State Altoona Code of Conduct. I also understand that it is important to the success of the present internship and the continuance of future internships that interns observe standards of conduct that do not compromise Penn State Altoona in the eyes of individuals and organizations with which it has dealings. Furthermore, I acknowledge the responsibility of my instructor to interpret conduct for this purpose. I agree that should my instructor decide that my internship must be terminated because of conduct that might bring the program into disrepute, or the internship into jeopardy, that decision will be final and may result in academic sanction.

Student Agreement

Internships authorized by Penn State Altoona are academic experiences offered by the College. As such, I agree to abide by the standards established by Penn State Altoona and the Office of Academic Affairs. I understand and agree to comply with the following:

I will meet with my academic adviser to discuss an internship experience that best suits my academic and personal needs. It is my responsibility to ensure that the internship course and number of credits for which I enroll fit appropriately with my degree program and my graduation plans.
I will conduct myself in a professional manner in all correspondence with prospective host sites and with all members of the Penn State Altoona faculty and staff with whom I consult regarding the internship.
I acknowledge that I may be required to purchase professional liability insurance prior to commencing my internship, especially if my internship involves regular contact with minors or other vulnerable populations. I understand that I am personally responsible for obtaining such insurance, if needed.
I will carefully consider all offers and obtain formal approval from my instructor before accepting an internship position. Once I have accepted an offer, I am obliged to honor my agreement. Acceptance can be in either verbal or written form.
Due to the nature of an internship arrangement, I may not withdraw from a placement except in severe and justifiable circumstances as determined by my instructor, and in consultation with the host site. An unjustified withdrawal from an internship may result in academic sanction.
Once I obtain an internship, I will behave in a professional manner and hold in professional confidence any information gained regarding the host organization.
If I feel victimized by a work-related incident (e.g., job misrepresentation, unethical activities, sexual harassment, discrimination, etc.), I will notify my instructor or the Academic Internship Coordinator immediately.
I will maintain an active Penn State email account while at my internship. I will inform the Academic Internship Office of this address and will check my Penn State email regularly (at least once a week).
If I am an international student, I will meet/talk with a representative of the International Student Office to discuss employment/educational requirements or restrictions.
If I plan to graduate the semester I am interning, I must turn in all required assignments by the deadline(s) established in the Educational Plan. Failure to meet this obligation may result in failure to graduate on time.

Internship Preparation

Have you completed, or are you currently enrolled in one of the following Internship Preparation Courses?

BA 420
CRIMJ 290
INTSP 370

Host Site Description and Pre-Internship Expectations

In the spaces below, provide a brief description of your proposed workplace responsibilities. Please enter the information in paragraph form. If you have an electronic version, you may copy (Ctrl + C) and paste (Ctrl + V) into the text boxes.

Company/Organization Description:
Please provide a three- or four-sentence description of the host organization, its products or services, and market scope (e.g., local, regional, national, international).
Work Environment:
Please note office/work space available, access to computer facilities, and any software or data needs for your internship.
Data Approval:
Is host site approval required for access to any data you may need to successfully perform your tasks or responsibilities? If so, have you received that approval?
Professional Contacts:
What professional networking opportunities, if any, are available through this internship? For example, opportunities to observe board meetings and participation in any local or regional professional associations or conferences.

Terms of the Internship

As deemed capable, I will assume additional responsibilities. I will not, however, routinely perform duties generally considered below the paraprofessional level.

My internship will begin on...
My internship will end on...
Hours per Week:
Number of Weeks:
Are you receiving monetary compensation for this internship?

Academic Objectives

With the assistance of your instructor, please formulate 3-5 learning objectives for the internship. Your objectives should tie the planned work experience to ideas, concepts, questions or dilemmas central to your course of study and/or to specific readings. The objectives should be discussed with and approved by both your faculty and host site supervisor.

Learning Objective #1 (required)

Learning Objective (What do I want to learn?)
Academic Significance (Why is this objective important for a student in your academic program? In other words, tie this objective to key concepts, theories, questions, or dilemmas that are central to your discipline.)
Responsibilities, Tasks, and Resources (How am I going to achieve this learning objective? Please refer to specific portions of your work proposal.)

Learning Objective #2 (required)

Learning Objective (What do I want to learn?)
Academic Significance (Discuss why this objective would be important for a student in your academic program. In other words, tie this objective to key concepts, theories, questions, or dilemmas that are central to your discipline.)
Responsibilities, Tasks, and Resources (How am I going to learn it? Please refer to specific portions of your work proposal.)

Learning Objective #3 (required)

Learning Objective (What do I want to learn?)
Academic Significance (Discuss why this objective would be important for a student in your academic program. In other words, tie this objective to key concepts, theories, questions, or dilemmas that are central to your discipline.)
Responsibilities, Tasks, and Resources (How am I going to learn it? Please refer to specific portions of your work proposal.)

Grading Criteria

(To be completed by your instructor)

Criteria
Evaluation Tool/Assignment (Fill out all that apply)	Due Date/Frequency of Submission (e.g., weekly, bi-weekly, midterm)	Relative Weight in Final Evaluation (e.g., 30%)
Tool or Assignment	Date or Frequency	Relative Weight
Tool or Assignment	Date or Frequency	Relative Weight
Tool or Assignment	Date or Frequency	Relative Weight
Tool or Assignment	Date or Frequency	Relative Weight
Tool or Assignment	Date or Frequency	Relative Weight

NOTE: An acceptable final evaluation from your host site supervisor is required if you are to receive a passing grade in this course.

Authorizations

Student

I understand that, together, the Work Proposal and Terms of the Internship constitute acceptable terms for the experiential component of the internship authorized by Penn State Altoona. I further understand that academic credit is granted for knowledge acquired through this experience, as evidenced by successful and timely completion of the assignments outlined by my instructor in the Grading Criteria Section of this Internship Proposal.

I understand that an acceptable final evaluation from my host site supervisor is a necessary condition for me to receive a passing grade in the course.

I also understand that under no circumstances will I be permitted to receive an increase or decrease in the number of credits for which I have contracted. It is further understood that my instructor has the option to revise due dates and that I should confirm these dates with him or her to avoid the possibility of conflict later. I understand that the final grade for my internship is given by the instructor with the advice of the host site supervisor.

Student Name (please print)
Student Signature
Date

Host Site Supervisor

I have reviewed the above Internship Proposal, and I agree that the Work Proposal accurately describes the planned internship experience.

I have / have not (circle one) recommended readings to provide the student-intern with background, skills, or perspective pertaining to the internship.

I agree to objectively evaluate the student intern's performance after two weeks, at the mid-point, and at the conclusion of the internship.

I prefer to complete these evaluations:

electronically (on-line)
in hard-copy via the US postal service

NOTE: Fax copies are discouraged as they are generally not readable.

Host Supervisor Name (please print)
Host Supervisor Signature
Date

Faculty Member

I have assisted the student in developing the above Internship Proposal. I agree to work with the student to facilitate the success of the internship and to objectively evaluate and grant credit for completed assignments as stated above.

Faculty Name (please print)
Faculty Signature
Date