University of California Merced
Student Success Internship
Intern Agreement (SAMPLE)
As a participating member in the Student Success Internship Program, I agree with and consent to the following:
As a participant maintain Student Success Internship Participation Requirements:
- Carry a full-time academic course load. (Full-time is 12 units)
- Maintain good academic standing and conduct compliant with University standards.
- Attend all orientation/training session(s).
Internship Role and Responsibilities
- Fulfill internship side department requirements:
- Meet bi-weekly with mentor-supervisor.
- Develop and respect work schedule negotiated with the mentor-supervisor.
- Support and complete projects assigned and undertaken.
- Devote 10-18 hours per week to work for host department fall 2016 - spring 2017.
- Submit bi-weekly, monthly and/or semesterly time sheets signed by my mentor-supervisor to by the 15th and 30th of each month.
- Do not exceed 18 hours per week in all of my combined on-campus employment without the express written permission of my mentor-supervisor and a Center for Career & Professional Advancement representative.
- Dedicate yourself learning and engaging the internship position and its responsibility.
Communication
- Regularly ask questions or request feedback from my mentor-supervisor regarding my work, projects and experiences in the department.
- Communicate with my mentor-supervisor regarding work schedule - commitments/conflicts.
- Communicate with mentor-supervisor regarding any problems or concerns with my internship.
Pay Rate
- The Student Success participant will pay rate of $15.00 per hour up to $4000.
Withdrawal
- I understand that spaces in the Student Success Internship Program are limited and by withdrawing from the program prior to its completion, I have taken away an opportunity from another student to participate.
- I understand that I forfeit any scholarship monies that were to be awarded to me at the completion of my internship by withdrawing from the program prior to the completion date.
Photo/Video/Audio/Publishing Release
- I understand that the photograph(s), videos or audio recording(s) taken of be by agents, employees or representatives of The Regents of the University of California (hereinafter "University") shall be used in connection with communication materials produced by the Student Success Internship Program for the University's dissemination of information on its programs.
- I also allow my written work to be quoted for the same purposes.
- I hereby irrevocably authorize the University to copy, exhibit, publish, or distribute any and all such images and audio of me or my written work or wherein I appear, including composite or artistic forms and media, I waive any right to inspect or approve the finished product, including written copy, wherein my likeness appears.
- I hereby hold harmless and release and forever discharge the University from all claims, demands and causes of action which I, my heirs, representatives, executors, administrators, or any other persons acting on my behalf or on behalf of my estate have or may have by reason of authorization.
Contact Information Release
- I consent to allow my name and contact information (email and telephone number) to be shared with other UC Mercedfaculty and staff, and Student Success Internship participants (past, present, and future) that may request it for the purpose of developing netowkring opportunities.
- I understand that UC Merced and/or student Success Intenrship Program will never share my information outside of the University without my exxpress written consent.
Additional Commitment
- I understand that a failure to meet the terms of this agreement can result in my separation from the program and withdrawal of any and all scholarship/stipend monies.
- If such a situation arises, I may be asked to pay back all or a portion of the fees paid by Student Success Internship Program.
Signature: Date:
Print Name: Student ID:
Email: Phone #:
Major: Anticipated Grad. Month/Year:
Internship Department: Mentor-Supervisor:
