MUHLENBERG COLLEGE
Internship Learning Contract
(to be completed by student)


Student:   You may make copies of this form, or open the MS Word version. Write this document in consultation with your faculty sponsor and site supervisor. When all have agreed on the content and all revisions of this document, you should prepare a final, clean, TYPED copy for signatures and distribution to all parties (student, faculty sponsor and site supervisor).

PART I


  1. Name _________________________________
    Campus Address
    Box #______ Muhlenberg College, Allentown, PA 18104

    ______________
    phone #
    __________________________
    email

    Berg ID # _______________________
    Home Address
    _______________________________
    street
    _______________________________
    city                               state         zip
    _______________________________
    phone #

    Your residential address while on the internship, if away from campus:
    __________________________________________________________________________
    street
    __________________________________________________________________________
    citystate                         zip
    ________________________________
    phone #
    ________________________________
    fax #



  2. Internship organization: __________________________________________
    Address: ________________________________________________________
    street                                             city                                       state         zip
    Mailing Address, if different than above: _____________________________
    Site Supervisor: __________________________________________________
    name                                                   title
    Phone #: ______________________________



  3. Faculty Sponsor: ________________________________________________________________
    name                                                                    department
    Office: ___________________________________     Phone #: ________________

    Academic Advisor: ________________________________________________________________
    name                                                                    department

    Office: ___________________________________     Phone #: ________________



PART II: THE INTERNSHIP

  1. JOB DESCRIPTION: Describe your role and responsibilities while on your internship. List duties, projects, deadlines and so on.








  2. HOURS: You are encouraged to set regular weekly hours for the duration of your internship. In order to receive academic credit, you must work 9-12 hours per week, and a total of 126-168 hours per semester. For summer internships, you must work no less than 126 hours. Please list hours:

    DayHours





  3. SUPERVISION: Describe the supervision to be provided by your site supervisor, faculty sponsor or others. What kind of instruction, assistance or consultation will you receive and from whom?







PART III: LEARNING OBJECTIVES/LEARNING ACTIVITIES

  1. LEARNING OBJECTIVES: What do you intend to learn through this experience? What abilities, skills, or knowledge do you intend to develop or enhance? Be specific. Use concrete, measurable terms.






     

  2. LEARNING ACTIVITIES:

    1. On-the-job: Describe your activities and how they will enable you to meet your learning objectives. Include projects, research, report writing, conversations which you will carry out while working, relating them to what you intend to learn.







    2. Academic and off-the-job: Describe in as much detail as possible your academic project. Also list reading, writing, contact with your faculty sponsor and other students, discussions, field trips, and/or observations you will carry out which will help you meet your learning objectives.





     

PART IV: EVALUATION

    How will you know what you have learned, or that you have achieved your learning objectives? How will your work performance be evaluated? By whom? When? How will a grade be determined? By whom? When? All parties should receive a copy of the evaluation form at the start of the internship experience.







PART V: AGREEMENT

    This agreement may be terminated or amended by the student, faculty instructor or site supervisor upon written notice, which is received and agreed to by the other two parties. This is a working agreement and does not constitute a contractual obligation for any of the parties concerned.


    Student signature: ____________________________ Date: __________________
    Faculty instructor: ____________________________ Date: __________________
    Site supervisor: ______________________________ Date: __________________

    (Copies of this signed agreement should be distributed to the student, faculty sponsor and site supervisor.)


Portions of this document are reprinted by permission of The Carroll Press, Cranston, RI, from The Experienced Hand: A Student Manual for Making the Most of an Internship, Timothy Stanton and Kamil Ali, National Society for Internships and Experiential Education, (c) Copyright 1982, from page 63 to 65.
 


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