Work-Based Education Program
INTERNSHIP/ SHADOWING EXPERIENCE AGREEMENT
\for the unpaid training internship or shadowing position of:
Student: Parent:
Address: Telephone: Cell:
Start date of internship: End date of internship:
Daily/Weekly time schedule:
COOPERATING BUSINESS/ORGANIZATION:
Address: Business Phone:
FAX:
Cell:
Internship Site Supervisor:
This training is organized as an unpaid internship in alignment with federal interpretation of student internships as follows:
1. The extent to which the intern and the employer clearly understand that there is no expectation of compensation. Any promise of compensation, express or implied, suggests that the intern is an employee - and vice versa.
2. The extent to which the internship provides training that would be similar to that which would be given in an educational environment, including the clinical and other hands-on training provided by educational institutions.
3. The extent to which the internship is tied to the intern's formal education program by integrated coursework or the receipt of academic credit.
4. The extent to which the internship accommodates the intern's academic commitments by corresponding to the academic calendar.
5. The extent to which the internship's duration is limited to the period in which the internship provides the intern with beneficial learning.
6. The extent to which the intern's work complements, rather than displaces, the work of paid employees while providing significant educational benefits to the intern.
7. The extent to which the intern and the employer understand that the internship is conducted without entitlement to a paid job at the conclusion of the internship.
Business/Organization
Student
Work-Based Learning Coordinator
GOAL(s) & PRIMARY QUESTION(s)
Learning Goal(s):
Primary Question(s):
Reflect on goal(s) in relation to PLP:
21st CENTURY & AOE TRANSFERABLE SKILLS / GRADUATION PROFICIENCIES
SPECIFIC WORKPLACE & CAREER SKILLS
Checklist of Insurance(s) and supporting documents:
-- Include Evaluation Form
TERMINATION
Termination of this agreement may be initiated by any of the participants. The Work-Based Learning Coordinator is responsible for the transfer or withdrawal of the student-learner at any time after evaluation of the placement situation and consultation with employer.
Student Signature Date
Parent/Guardian Signature Date
Program Instructor Signature Date
Work-Based Learning Coordinator Signature Date
Employer Signature (& title) Date
** The Work-Based Learning Program operates in accordance with all federal and state laws and regulations regarding nondiscrimination of participants on the basis of age, race, color, national origin, gender, sexual orientation or disability.