INTERNSHIP AGREEMENT FORM
GRADUATE DIVISION
Department of Sociology ● IUPUI
425 University Blvd. ●CA 303 ●Indianapolis, IN 46202-5140
Telephone: 317-274-8981 ● Fax: 317-278-3654 ● Email: sociolog@iupui.edu
● Web:  http://www.iupui.edu/~slasoc/

This form is used to coordinate and clarify the expectations and responsibilities of the student, the agency, and the faculty committee chair.

STUDENT INFORMATION – completed by student
This internship proposal is presented for ________ credits.

Name:

Email:                                                                                           Phone:

Address:

City, State, Zip Code:

I am aware that the Internship Program may contact my employer to assess my progress. This information may be discussed with my academic department: University ID#: _______________

1.       What specific role will you play in the agency?

2.       Describe your goals and the work experiences which you expect to obtain, and the anticipated sociological relevance for your internship.

3.       Briefly describe the final paper that you expect to submit as the formal component of your internship. 

________________________________                          ______________________
Student Signature                                                              Date                                                                                                                                                                                                   p. 1 of 3

INTERNSHIP AGREEMENT FORM
GRADUATE DIVISION
Department of Sociology ● IUPUI
425 University Blvd. ●CA 303 ●Indianapolis, IN 46202-5140
Telephone: 317-274-8981 ● Fax: 317-278-3654 ● Email: sociolog@iupui.edu
● Web:  http://www.iupui.edu/~slasoc/
 (for departmental records)

This form must be completed and submitted to the Director of Graduate Studies within 5 days after completing the internship requirements of the Masters Degree in Sociology.  

AGENCY INFORMATION – completed by the employer in conjunction with the student

Company/Agency Name:

Internship Supervisor and Title:

Email:                                                                                                    Phone/Fax:

Address:

City, State, Zip Code:

1.       Salary (If applicable)

2.       Hours per week:  
                         
3.       This student:   __ is new to this job/agency.
          OR                __is currently employed at this job/agency. How long? _______
                               __has been previously employed at this job/agency. How long? _______

4.       Describe in detail all work tasks and responsibilities (use additional pages if more space is needed):

__________________________       __________________________        _____________
Agency Supervisor Signature                     Printed                                     Date
                                                                                                                                                       p. 2 of 3

FACULTY SUPERVISOR INFORMATION: completed by the student’s internship Chair

Faculty Name:                                                Title:

Department                                                    Email:

Phone:                                                            Fax:                                              Campus Address:
1.       Please select the forms of documentation which the student is to submit to you as part of the internship requirements at a minimum, the student must complete a journal and a final paper):

___     Weekly Journal of Activities (Turned in weekly)
___     Student Evaluation Form (student evaluates his/her performance and the employer for future internships at the end of the semester). 
___     Employer Evaluation Form (employer evaluates the student’s performance at the end of the semester and submits this form directly to the faculty supervisor.
___     Final Paper (written per your instructions)
___     Evidence of Presentation of the Student’s internship experience
___     Other_______________________________________________________________

2.       Additional Comments:

______________________________________                  __________________________
Internship Graduate Committee Chair Signature                                                         Date        

FACULTY MEMBER INFORMATION: completed by the student’s committee member

Faculty Name:                                                Title:

Department                                                    Email:

Phone:                                                            Fax:                                              Campus Address:

The above described internship has been presented for your approval

_________________________________                                 ______________________
Internship Committee Member Signature                                                             Date             p. 3 of 3