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Student Internship Agreement Form

Communication Studies Internship Program
Portland State University
Student Internship Agreement Form

Employer Name: ____________________________________________
Employer Address: ___________________________________________
City: ______________________ State______ Zip Code: _________

On-site Supervisor Name: _____________________________________

Position or Title: ___________________________________________
Phone: ____________________ Fax: ________________

Email: ______________________

Description of Internship Duties:

 

 

# of Internship Credits Student is Taking This Term:__________ 

Credits and Internship Hours:
    150 hours = 4  credits  = Approximately 15 hrs/wk.
    250 hours = 8  credits = Approximately 25 hrs/wk.
    400 hours = 12 credits = Approximately 40 hrs/wk.

Work Schedule:

Arrival and Departure Time:   ____________ to ______________

# of Days Per Week _______________             Approx. Hours Per Week: ___________
The employer agrees to provide:
  • Job supervision throughout the student's internship experience.
  • Feedback on the intern’s performance.
  • Complete a Performance Evaluation - due no later than the 9th week of the academic term.
    (Evaluation Form will be provided by the Communication Studies Program)
 
Internship Site Supervisor (Signature) ____________________________      Date _________
Student Intern Name (Please print) ______________________________
Student Intern (Signature)    ___________________________________     Date _________