Name ____________________________________________SS # _________________________________

Home Phone ____________________________________Major___________________________________

Faculty Coordinator Dr. Sara Horsfall Department __Sociology/Criminal Justice______________________

Agency or organization for internship_________________________________________________________

Which semester do you plan to participate? ___________________________________________________

1. I acknowledge and understand my responsibilities as a student participating in the Internship Program as outlined in the Student Bulletin for Internships.

2. I understand that it is my responsibility to meet the requirements as established by my academic department coordinator.

3. I will be responsible for completing all of my work assignments and obligations by their respective deadlines.

4. I understand that, upon completion of my experience, I will complete a Post-Work Evaluation and return it promptly to Texas Wesleyan officials.

5. I will adhere to all program regulations and requirements as a student enrolled at Texas Wesleyan University.

6. I will report to work on time or, in the event of illness or emergency, I will notify my internship site supervisor(s) promptly.

7. I will report to my academic department coordinator at once any situation which could be detrimental to the Internship Program or to me.

8. If, for any reason during this work assignment, I am removed from my position, I will not apply for unemployment benefits. I understand that this program is an academic program, not an employment program.

9. I understand that no life experience will be accepted for internship credit by Texas Wesleyan University.

10. I understand that the final grade and academic credit for any internship will be determined by the faculty coordinator in each department, using information supplied by the internship site supervisors.

In consideration for being allowed to participate in the Internship Program, I do hereby release and discharge all employees of Texas Wesleyan University from any and all liabilities, causes of action, costs, charges, claims, expenses, and demands, as well as from damages incurred by me as a result of my participation in the Internship Program.

By signing below, I hereby expressly assume any and all risks which may be incumbent with my internship. Additionally, I hereby expressly agree forever to refrain from suit or proceeding at law against Texas Wesleyan University and the internship sponsor for any personal injury or property damage incurred because of my participation in the Internship Program.

I have read, understood, and agreed to the terms herein.
 
 

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