Internship Proposal Agreement Template

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Syracuse University Internship Proposal/Agreement


Complete this two-page form to earn credit (recorded on the academic transcript as Experience Credit) for an
internship. This form must be submitted and approved before the start of the internship.

Student intern, please complete ALL information on this page:

Student Name SUID #

College(s) Major(s) Level Fr So Jr Sr


(during int'p) Grad Non-matric
E-mail Phone

Semester or Summer Session (choose one):

Fall Spring Summer Sess I (6 wks.) Summer Sess II (6 wks.) Summer Comb. Sess (12 wks.)
Is this internship being done through SUAbroad? Yes No

Year Internship Start Date: Internship End Date:


Course: Dept/Coll 3-Letter Prefix: Course Number: 270 470 670
Number of credits: x 45 hours = (minimum number of internship-related hours to be worked)
Title: Experience Credit Grading Basis: letter grade A-F or pass/fail (undergrads only)

Class number (to be assigned by Registrar's Office --student, do not fill in)

SU Faculty Sponsor Name (printed) Coll & Dept.

E-mail Last 4 digits of SUID


(Faculty member please provide)
Student is responsible for checking with academic department and/or college for rules on number of credits and grading basis.
• Internships must be registered for the academic term in which the internship work is begun.
• Internships which extend over two terms (but not two summer sessions) must be registered as two separate internships.
• Minimum 45 total hours of internship work required per credit. More than the minimum may be worked without registering for
additional credits, and all hours worked under faculty oversight during the stated term are considered part of the internship.
• Registration for credit-bearing Experience Credit cannot be done retroactively for an internship performed without faculty
oversight.

Internship Site Information


Organization name & physical address:

Organization contact's (E.g., Intern Coordinator or Human Resources): Name

Title, e-mail, phone number:

Intern's site (work) supervisor: Name Title

E-mail Phone

Does the organization require credit registration as a condition of doing this internship? YES or NO

I understand that tuition will be charged for internship credits on the same basis as it is charged for other credits
during the same academic term (fall, spring, or summer).

I understand that Internships that do not extend over the entire semester or summer session are considered
“flexible format” and have deadlines unique to that internship. (Please contact internship or registrar staff for
deadlines specific to your internship.)

Signed (student) Date

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INTERNSHIP LEARNING AGREEMENT

Faculty sponsor and/or student, please fill in clearly and completely.

1. Objectives / learning goals: What does the student want to learn from this internship?

2. Anticipated activities and tasks of internship: How does student expect to accomplish the learning?

3. Required supplemental assignments and communication with faculty sponsor

4. Criteria for assessing student’s academic performance:

Agreed:

Student Signature Date

Faculty Sponsor Date

Internship Proposal/Agreement Approved:

Student’s academic advisor: Signature Date

Dept. chair/college rep.: Signature Date


SU Career Services, Internship Staff Initials: Date
(for participating colleges/programs only)

College Undergraduate/Graduate Office: Signature Date

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