Name: ________________________________________________________________
Internship Site: _______________________________________________________
Do you have Health Insurance: __________ Through URI or Personal: ___________
Please write WHAT your duties and responsibilities will be AND your RATIONALE for wanting to do this internship:
I, _____________________________(your name) agree as a student intern that I will receive ________ (# of college credits) when I have successfully completed not only the # of hours I must perform per credit but also the weekly e-mails, the mid-term and final paper and the 3-events with Career Services. The mutual goal, along with the university & internship supervisor, is to have a reasonably safe environment with the necessary tolls to perform the internship. If, after consulting with Sharman Brown (Internship Coordinator) there is any reason that I feel this internship experience isn’t working to my expectations I may terminate. The internship site may pay me for this experience, but they are not obligated to do so. Also, If at any point I experience ANY work place violation I will let Sharman Brown know.
Student Signature: ______________________________________ Date: ________________
Emergency Contact Person: _______________________________ Phone #: _____________
Sharman Brown Signature: ________________________________ Date: ________________