Internship Student / Agency Contract
AGENCY INFORMATION
Agency Name: 
Sector: 
Address: 
City State & Zip: 

Supervisor Name & Title: 
Supervisor Email: 

INTERNSHIP INFORMATION
Internship Dates: 
Work Schedule: 
Hourly Rate of Pay: 
Internship Job Title:

1. Job Responsibilities (include specific duties/responsibilities)


2. Describe the potential for student learning involved in this internship/this agency?


3. Describe the level of supervision/mentoring to be expected as part of this internship


4. Goals to be realized by the end of employment period