Department of Technical Education
FORMAT - 3
Agreement
This Agreement is between the student, cohort owner and internship provider. It shall serve
to clarify the educational purpose of the internship and to ensure an understanding of the
total learning experience among the student, cohort owner and Industrial training supervisor
Part I: Contact Information
Student
Name: Student ID Class Year:
College Address: City, State:
Phone: Email:
Industrial Supervisor
Name: Designation:
Company/Organization:
Address: City, State-----------------------Pin:
Phone: Email:
Cohort owner
Name: Designation:
College Address:
Academic Credit Information
Program:
Pathway: ---------------------------------------- Credits: 16
Beginning Date: Ending Date:
Hours per Week: 40
Part II: The Internship
Internship Objectives:
Describe What do the interns intend to learn, acquire skill through this internship? Try to use
concrete, measurable terms in listing the learning objectives under each of the following
categories:
Knowledge
Skills
Job Description:
Describe in as much detail as possible intern’s role and responsibilities while on internship.
List duties, project to be completed, deadlines, etc. Describe How interns’ technical
knowledge can be applied at the site of the internship and how they can create value to the
organization through internship
Supervision: Describe in as much detail as possible the supervision to be provided/needed
at the work site. List what kind of instruction, assistance, consultation interns will receive
from whom, etc
Evaluation: Describe How will interns work performance be evaluated? By whom? When?
Part III: Agreement
This Agreement may be terminated or amended by student, cohort owner or industry
training supervisor at any time upon 7days written notice, which is received and agreed
to by the other parties.
Student Date
Cohort owner Date
Industry Training Supervisor Date