OBJECTIVES/ GUIDELINES/ AGREEMENT: INTERNSHIP SYNOPSIS
An internship is a unique learning experience that integrates studies with practical work. This
agreement is written by the student in consultation with the faculty Mentor and Industrial
supervisor. It shall serve to clarify the educational purpose of the internship and to ensure an
understanding of the total learning experience among the principal parties involved.
Part I: Contact Information
Student
Name: ______________________________ Student ID#______________ Class Year: ________
Campus Address: _______________________________________________________________
City, State: ____________________________________________________________________
Phone:_____________________________Email:_____________________________________
Industrial Supervisor
Name: _____________________________________Title: ______________________________
Company/Organization: __________________________________________________________
Internship Address: _____________________________________________________________
City, State, Pin: _________________________________________________________________
Phone: ___________________________Email: _______________________________________
Faculty Mentor
Name: ________________________________________Phone: __________________________
Campus Address: _______________________________________________________________
Academic Credit Information
Internship Title: ___________________________Department: __________________________
Course #: ____________________________________ Credits: __________________________
Grading Option: ________________________ Credit/Non-credit _________________________
Beginning Date: _____________________________Ending Date: ________________________
Hours per Week: _____________________Internship is: ______Paid_____Unpaid____________
Part II: Internship Objectives/Learning Activities
Internship Objectives: What do you intend to learn, acquire and clarify through this internship?
Try to use concrete, measurable terms in listing your learning objectives under each of the
following categories:
• Knowledge and Understanding
• Skills
Learning Activities: How will your internship activities enable you to acquire the
knowledge/understanding, and skills you listed above?
On the job: Describe how your internship activities will enable you to meet your learning
objectives. Include projects, research, report writing, conversations, etc., which you will do while
working, relating them to what you intend to learn.
Teaching/Mentoring Activities: How your technical knowledge can be applied at the site of the
internship. How you can create value through mentoring/help people learn new things.
Off the job: List reading, writing, contact with faculty supervisor, peer group discussion, field
trips, observations, etc., you will make and carry out which will help you meet your learning
objectives.
Evaluation: Your Internship supervisor will provide a written evaluation of your internship.
Describe in detail what other evidence you will provide to your faculty Mentor to document what
you have learned (e.g. journal, analytic paper, project, descriptive paper, oral presentation, etc.)
Include deadline dates.
Part III: The Internship
Job Description: Describe in as much detail as possible your role and responsibilities while on
your internship. List duties, project to be completed, deadlines, etc. How can you contribute to the
organization/site of internship?
Role of Supervisior: Describe in as much detail as possible the supervision to be provided/needed
at the work site. List what kind of instruction, assistance, consultation you will receive from whom,
etc.
Evaluation: How will your work performance be evaluated? By whom? When?
Part IV: Agreement
This contract may be terminated or amended by student, faculty coordinator or work supervisor at
any time upon written notice, which is received and agreed to by the other two parties.
Student ___________________________________ Date ________________
Faculty Mentor _____________________________ Date ________________
Industry Supervisor _________________________ Date ________________
