ࡱ> jli O/bjbjUU \?g?g$5EP P VVVjjj8lDj?<bR(z,,,;;;;;;;$>WA;V,T,|,,,;; 1 1 1,RV; 1,; 1 1r9T4":-&:;<0?<4:A.~A::AV:,, 1,,,,,;;/~,,,?<,,,,A,,,,,,,,,P X : OUniversity of Colorado at Boulder Ketchum 195 Department of Sociology 303-492-5217  This Agreement is made between the following University of Colorado Boulder student (the Student) and the organization that is providing the internship experience (Internship) to the Student (the Organization). This Agreement does not create any obligations on the part of the University of Colorado Boulder (university). The Academic Department, Sociology (Department). The universitys Career Services office may utilize or reference this Agreement as necessary, including, but not limited to, for the approval of internship credit, compilation of statistics regarding university internships, evaluating insurance sponsorship, etc. Completion of this Agreement is necessary to ensure a high-quality experience and satisfaction between the Student and the Organization. Completion of this Agreement is also necessary for the Student to receive academic credit for the Internship. This Agreement includes an Internship Learning Plan to facilitate these goals. By signing this Agreement, Student and Organization acknowledge that they understand and agree to the responsibilities under this Agreement, including the Internship Learning Plan. A completed and signed copy of this Agreement should be returned to Glenda Walden ( HYPERLINK "mailto:Glenda.Walden@Colorado.edu" Glenda.Walden@Colorado.edu) in order to gain permission to enroll in either Socy 4931, 4932 or 4935 I. For what course are you intending to register? Socy 4931 Socy 4932 Socy 4935 Credits Requested: ____________ (90 hours 3 units; 130 hours 4 units; 170 hours 5 units; 210 hours 6 units) Will you be working on-site (at the organization) or remotely? _______________ II. STUDENT INFORMATION First Name: __________________________ Last Name: __________________________ Student ID: __________________________ Anticipated Graduation: ________________ Email: ________________ Phone: ________________ Class Standing at start of internship semester: ______JR SR__________ Major(s): __________________________ Minor: ________________ Local Address (where will you be living during your internship): City: _______________ State: _______________ (Country if Outside US): _______________ III. ORGANIZATION INFORMATION Company/Organization Name: __________________________ Type of industry or agency: __________________________ Street: _________________________ City: _________________________ State: _______________ Zip: _______________ Individual Providing Supervision to Student at Company (Work Supervisor): Name: ________________ Role/Title: ________________ Email: ________________ Phone: ________________ IV. INTERNSHIP INFORMATION Position Title: ________________________________________________ Start Date: ________________ End Date: ________________ This internship is (select one): Unpaid Student will receive NO remuneration Paid Student will receive remuneration If paid, salary (or per hour): ________________ Hours per week: _________ Total Hours: _________ V. INTERNSHIP LEARNING PLAN Student - please answer the following questions relating to the Internship: Describe the nature of your position: List your work responsibilities and duties: What are your learning goals in terms of educational, personal, and career objectives during this internship? How are you going to accomplish these objectives? Discuss with your supervisor and include here how your duties will facilitate your objectives stated above. For academic/educational goals (from Sociology Internship Coordinator): The student will be discussing with other students their experiences and offering feedback around questions other students may pose about their experiences. Students will also write a reflection paper early on, describing their organization in terms of their mission framed within sociological understanding of social problems or personal troubles and public issues and a larger analysis paper at the end of the semester exploring some aspect of their organization or experience from a sociological perspective, grounded in the literature of general sociology, Care Health and Resilience literature, or Social Innovation literature. Finally, students will complete a detailed Self-evaluation of their experience reflecting on skills acquired, challenges, how well the experience supported their learning objectives, and assessing the quality of the experience including supervision received at the organization. How will you evaluate the learning experience? What evidence will you provide to document your accomplishments? Discuss with your supervisor what their evaluation of you will be based upon and how you both will decide if objectives of the internship have been met. For academic goals (from Sociology Internship Coordinator): Students will submit online discussions, 1 reflection paper, 1 self-evaluation, 1 updated resume (after consulting with Career Services), and 1 15 page analysis paper to the Sociology Department Internship Coordinator who is the instructor of record for the course (socy 4931, socy 4932, and socy 4935). How often will you be provided feedback on your fulfillment of hours, how well you are meeting expectations, and suggestions for improvement by your Organizations supervisor? (We suggest meeting no less than once a month throughout the semester) By what method (in person, via zoom or other online format, etc): VI. STUDENT AND ORGANIZATION RESPONSIBILITIES A. Student By signing this Agreement, Student agrees to the following responsibilities for the duration of the Internship: 1. Perform to the best of Students ability those tasks assigned by Students supervisor, which are related to Students learning objectives and the responsibilities of the Internship position. 2. Follow all the rules, regulations, and normal requirements of the Organization's organization. 3. Notify Academic Department of any changes Student may need to make in the Internship Learning Plan or of any problems that develop during the placement. 4. Complete an evaluation of the Internship. 5. Student must obtain and maintain health insurance during the duration of the Internship and provide proof of health insurance, if requested. B. Organization By signing this Agreement, Organization agrees to the following responsibilities for the duration of the Internship: 1. Provide the necessary orientation, training, precautionary safety instructions, and supervision to Student in the performance of the Internship duties and responsibilities, as listed above. 2. Assign Student work activities relevant to Students professional development, enable Student to progressively learn, and provide a variety of appropriate tasks concurring with the objectives of Students academic degree program. 3. Adhere to the  HYPERLINK "https://www.naceweb.org/career-development/organizational-structure/principles-for-ethical-professional-practice/" National Association of Colleges and Employer Principles for Professional Practice. 4. Conform to all federal, state, and local laws and regulations applicable to the Internship. 5. Limit access to Students files and personal information and maintain such files and personal information in confidence. 6. If Internship is paid: Pursuant to Colorado Revised Statute 8-40-302(7), Organization is responsible for providing workers' compensation and liability insurance coverage to Student receiving remuneration for the bona fide cooperative education or student internship program (the Internship). Accordingly, Organization agrees to provide workers' compensation and liability insurance in accordance with Colorado state law. Internship Supervisor initial here acknowledging responsibility to provide coverage if internship is paid: ______________ 7. If Internship is unpaid: The University encourages Organizations to extend workers' compensation coverage to all students completing internship experiences, whether paid or non-paid, because the Organization can best control the safety of the work place and provide accordingly for the risks a student may incur. Internship Supervisor initial here if Organization will be providing coverage to Student for unpaid internship: ___________ Internship Supervisor initial here if Organization will NOT be providing coverage to Student for unpaid internship: ___________ 8. Complete a final written evaluation of the student's performance during the placement. This is a one-page form that will be sent to you by the Sociology Department Internship Coordinator one week before the end of the semester. Its completion and return by the end of the semester is necessary for the student to receive credit for the internship. VII. SIGNATURES Please sign after review of the contract with Student and Internship Site Supervisor. Your signature means that you have read and agreed to this Agreement, including the Internship Learning Plan. Student printed name: ___________________________________________________ Student Signature: ___________________________________________________ Date: _________________ Work Supervisor printed name: ________________________________________________ Work Supervisor Signature: ___________________________________________________ Date: _________________       PAGE \* MERGEFORMAT 2 Received by Career Services Career Services Liaison __________________________ Date ___________ Received by Academic Department By signing below, I certify that the Student has received Department approval to complete the Internship described in the Agreement for academic credit. Student will receive ___ credit hours upon completion of the Internship and course requirements. 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