Directions to complete the attached form APPLICATION FOR INTERNSHIP CREDIT 1. If you have not already secured an internship, an important first step is to research potential internship sites on CareerConnect and CareerShift. You have an account set up for you in each system which is accessible through the Mercyhurst Career Development Center s portal page. a. To facilitate the internship placement process, use the search functions to locate Mercyhurst alumni who might be willing to host the internship or contact. The alumnus may also be willing to contact a colleague at an organization you are interested in on your behalf. b. Review the list of internship sites for your major; copies are available outside of Old Main 209. 2. Complete the attached application. Be sure to identify potential internship sites and write a summary of your preferred internship placement to facilitate the process. 3. When you take the application to your academic advisor to get their signature, discuss with them your preferred choices of placement listed on the application. a. Try to find an internship that can provide an experience that matches your career goals. 4. Once you ve discussed your internship preferences with your advisor and secured their signature on the application, schedule an appointment with Dr. Foust in Old Main 209 (ext. 2171) to discuss the internship placement process and your internship preferences. 5. You re required to attend an Internship Information Session (dates are posted outside Old Main 209) and on CareerConnect before you officially begin your internship. It s recommended that you attend the information session at least a semester before your internship placement. Distributed by the Mercyhurst University, Internship Program Director, Dr. Kyle Foust, 89 Old Main 209 Phone-824-2171 kfoust@mercyhurst.edu
MERCYHURST UNIVERSITY APPLICATION FOR INTERNSHIP PLACEMENT **** Complete and submit this application to the Internship Director, Dr. Kyle Foust 89 in Main 209 ***** NAME STUDENT ID # E-mail CELL PHONE ( ) Preferred semester for placement (check one): Fall Spring Summer Academic level/student type during placement (check one): Certificate Associate Freshman Sophomore Junior Senior Post-Bacc Grad/Masters Expected month and year of graduation: December / May (circle one) Year Your Major: Your Minor/Concentration (if applicable): Preferred Number of Internship credits: (0, 3, 6, 9): Current GPA: ** Internship credits are charged the same tuition rate as other 3, 6, or 9 credit courses Below, in order of preference, list your preferred internship choices. Refer to the list of previous internships located outside Egan 214 and conduct basic searches on CareerConnect and CareerShift to find potential internships sites. Name of the How did you find out about the internship; i.e. list of CareerConect (CC) Organization established internships, referred by parent/professor, Job ID# (if applicable) CareerShift, applied directly with the organization, etc? 1) CC Job ID # 2) CC Job ID # 3) CC Job ID # 4) CC Job ID # ** If you are interested in working for an organization that you found on the web or were referred to by a parent, friend, professor, etc., do you know if the organization participates in internship programs? Yes No Page 1 of 4
SUMMARY OF PREFERRED INTERNSHIP PLACEMENT *** To assist your academic advisor and the Internship Director in finding you a placement that is in alignment with your career goals, please write a short paragraph outlining what duties you would like/prefer to perform in an ideal internship? PERMISSION TO COMPLETE THE INTERNSHIP FROM YOUR ACADEMIC ADVISOR ** The signature below from your Academic/Faculty Advisor indicates you have their permission to complete an internship under the supervision of Dr. Foust. If the form is returned to Dr. Foust without a signature, it will be returned to the student without further action until the form is signed. **** The Academic/Faculty advisor should not sign the form unless potential internship placements are identified on the application. If the faculty has any reservations about the student succeeding in an internship placement, those reservations should be discussed with the student. Name of Academic/Faculty Advisor (please print) Date Signature of Academic/Faculty Advisor: INFORMATION BELOW TO BE COMPLETED BY THE MERCYHURST INTERNSHIP DIRECTOR: Internship Course Dept., i.e. MKTG: Site of Placement Immediate Supervisor Alum Y / N Supervisor s Title Course #; i.e. 473, 475, 476, 675: Rate of pay Start date End date Supervisor s Phone # Supervisor s email Office/internship information.application.internship.revised.4.27.16 Page 2 of 4
MERCYHURST UNIVERSITY INTERNSHIP PROGRAM GENERAL INFORMATION/ ASSUMPTION OF RISK AND RELEASE FROM LIABILITY UNEMPLOYMENT COMPENSATION The Mercyhurst University Internship Program is an academic instructional program that meets the requirements of the Federal Unemployment Tax Act of 1971 which excludes all students in such programs from claiming unemployment compensation. As services performed by these students are in connection with the Mercyhurst University Internship Program, wages paid (if any) for this service should not be reported for unemployment tax purposes and are not subject to unemployment tax. PERMISSION TO RELEASE CREDENTIALS I authorize Mercyhurst University to send copies of my resume, transcript, references and other required materials for organizations to consider my candidacy for an internship. I understand the above and grant permission where necessary: Participant Signature Date: ASSUMPTION OF RISK AND RELEASE FROM LIABILITY ** NOT APPLICABLE TO THOSE STUDENTS WHO COMPLETE AN INTERNSHIP WHEN IT IS A REQUIREMENT OF THEIR ACADEMIC PROGRAM. This Assumption of Risk and Release from Liability pertains to activities related to an internship undertaken by the Student (identified below) for academic credit through Mercyhurst University Career Development Center ( Internship ). Participation in this Internship may involve activities which pose the risk of physical or other harm to the Student, including but not limited to, risks arising from travel by automobile or other means to an off-campus internship site(s) and risks that may be posed when working at the affiliated site and/or its clientele. The selection of the particular Internship, including the affiliated site, the affiliated site s location, and the Internship activities contemplated, is entirely at the discretion of the Student. I, ( Student ), have enrolled in an Internship in which I will be interning with, located in. I hereby state the following: 1. I understand that I am responsible for providing my own transportation to and from the Internship site(s) and any additional off-campus sites at which Internship related activities will take place. I further understand that certain risks are inherent in travel and I fully accept those risks. These risks may include, but are not limited to, such things as traffic accidents and any resulting personal injury (including death) or property damage suffered by myself or a third party, traffic tickets, penalties, flat tires, driver error (including my own), adverse weather conditions, and other physical, mental and emotional injury. Page 3 of 4
2. I understand that there are certain inherent risks posed by this Internship and inherent to the particular services and activities contemplated by my participation in providing services at the affiliated site and perhaps its clientele. These risks may include, but are not limited to, risk of bodily harm, public health risks, communicable disease, criminal activity, illness, loss, damage or theft of personal property, and other mental, physical or emotional injury, including the risk of injury or death. I further understand that there are risks that are neither known nor reasonably foreseeable and I fully accept those risks. 3. I have attended an information session conducted by the Career Development Center (or agree to attend) and read (or agree to read upon receipt) the Internship syllabus provided by the Career Development Center and will abide by the terms and conditions therein; I will also familiarize myself with and abide by any rules and regulations of the affiliated site. I fully understand the above risks and the scope of activities contemplated by the Internship, and I agree to assume the risks of my participation in the Internship, including the risk of catastrophic injury or death. 4. I understand that Mercyhurst University does not provide insurance to cover medical expenses for injuries that may be sustained by me or for damage to my personal property or third parties, nor does it provide travel or vehicle insurance of any type that would cover injury to or death of myself or any third party or damage to the property of myself or any third party. I understand that Mercyhurst University strongly recommends that I carry my own health, medical and property insurance for purposes of potential loss related to my participation in this Internship. 5. I fully understand that all Mercyhurst University policies and regulations, including those embodied in the Internship syllabus provided to me upon placement in the field and in the Code of Student Conduct are in effect and apply to my behavior for the entire duration of the Internship and that any violations of these policies or regulations may result in sanctions. 6. I FULLY UNDERSTAND THE SCOPE OF RISKS OUTLINED ABOVE AND I RELEASE AND FULLY DISCHARGE MERCYHURST UNIVERSITY, AND ITS TRUSTEES, OFFICERS, EMPLOYEES, AND AGENTS, FROM ALL CLAIMS, DAMAGES, COSTS OR LIABILITIES OF ANY KIND WHATSOEVER IN CONNECTION WITH MY PARTICIPATION IN THE INTERNSHIP, FOR OR ON ACCOUNT OF ANY INJURY, ILLNESS OR DEATH, OR FOR OR ON ACCOUNT OF ANY LOSS OR DAMAGE TO ANY PROPERTY, SUSTAINED BY MYSELF OR ANY THIRD PARTY. Participant Signature: Date: Printed Name: If Participant in under 18 years of age, then his/her parent or guardian must also sign below: Parent/Guardian Signature: Date: Printed Name: Page 4 of 4