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

Fields marked with an asterisk (*) are required.

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