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Internship Contract
A. Student Information
 
Student Id Number(required)
 
First Name(required)
 
Last Name(required)

Preferred First Name
 
Gender(required)
 
Local Address(required)
 
City(required)
 
State(required)
 
Zip(required)
 
Local Phone(required)
() -
 
E-mail(required)
 
Campus Mail (required)
 
Box Number
 
Academic Major (required)
 
Class (required)

If this is a summer internship, be sure to indicate your summer address

B. Internship Work Site Information
 
Company/Agency(required)
 
Address(required)
 
City(required)
 
State(required)
 
Zip(required)
 
Country (required)
 
Phone(required)

Fax
 
Worksite Supervisor First Name(required)
 
Last Name(required)
 
E-mail(required)
 
Indicate which applies to you (required)
 
Compensation Amount
 
How did you find this internship? (required)
 
Is this internship outside of the United States? (required)

C. College Information
 
Internship Semester(required)
 
Year(required)
 
Faculty Internship Advisor(required)
 
Phone(required)
() -
 
Department Name(required)
 
Course Number (required)
(Course Number Information: Internship = Soph 290; Jr/Sr 490; Field Study = Fresh/Soph 280; Jr/Sr 480)
   
Number Of Credits(required)
A maximum of 12 internship credits is allowed during your entire college career.  If the credits listed on this contract cause you to exceed the limit, the Registrar will contact you and advise you to petition for additional internship credits.
 
Title of Study to appear on your transcript (Limited to 19 characters)(required)

D. Student's Learning Goals

You must have your advisor's guidance in setting these goals
 
1(required)
 
2(required)
 
3(required)
 
4(required)
 
5(required)

E. Internship Work Site Responsibilities
 
Work Site Activities (i.e. specific projects, job duties, assignments, etc.) (2000 characters max) (required)

F. Faculty Requirements
 
Supplemental reading, time log, journal reports, reflective paper, ongoing meetings, evaluation (2000 characters max) (required)

G. Internship Office Requirements

  • Orientation
  • Student Evaluation
  • Contract
  • Exit Interview
  • Pre-Internship Inventory
  • Time Log
  • Change of Schedule Form
  • Resume
  • Risk Assessment Form
  • Post-Internship Questionnaire
  • Post-Internship Inventory
  • Copy of Reflection Paper (if required by faculty internship advisor)

After your contract has been submitted, please print the summary page and take it to receive the proper signatures. Once this is done, return your contract to the Whitworth University Internship Office.


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Campus Telephone: 509.777.1000