Learning Agreement Form for Interns in the College of Liberal Arts & Sciences

Name of Student First Last
Student's Major *
Student's Minor
Student's Email
Student's Phone - Area Code - Prefix Line Number
Semester & Year of Internship *
Name of Supervising Faculty Member *
Supervising Faculty Member Email
Name & Number of Internship course (ex: SOC S494, Field Experience in Sociology) *
Number of Credit Hours of Internship 0 4 1 5 2 6 or more 3
Number of Hours of Internship-related Work Required for the Semester
Is the internship on or off campus? on campus off campus
Name of Agency/Organization *
Address of Agency/Organization: *
Street address Address line 2 City State/Province/Region Postal/Zip code Country
Supervisor Name and Title First Last
Supervisor's Phone - Area Code - Prefix Line Number
Supervisor's Email
Is this Internship Paid? Yes No
Internship Job Title *
Brief description of internship duties & responsibilities
Start Date / MM / DD YYYY
End Date / MM / DD YYYY
Weekly work schedule - list days and times
Student’s Personal Goals for Internship