Career Services Internship/Teaching Consent Form

To participate, graduate student must be post-comprehensive or complete the internship/teaching experience during the summer. Any exceptions to this must be approved by the student's program director and PI. This form should be completed for all internal and external internships, off-campus teaching, off-campus research, special projects and job shadowing/externship experiences.

Timeline
This form and required attachments must be submitted by the deadlines specified below.

Summer experience: April 30 deadline
Fall experience: June 30 deadline
Spring experience: Oct. 31 deadline
Student/Academic Information




Must be @psu.edu or @pennstatehealth.psu.edu address






Include semester and year





Must be @psu.edu or @pennstatehealth.psu.edu address


Must be @psu.edu or @pennstatehealth.psu.edu address
Internship/Teaching Site Information







Current funding (from stipend) may be adjusted accordingly


Internship/Teaching Timeline





Site Supervisor





Must be company email address
Learning Statement

Briefly describe your interest in completing this internship/teaching opportunity. What do you hope to learn through this experience? How does this fit into your long-term career goals?
Course Credit


Example: BIOSTAT 595


Example: Summer 20XX
Signature
The information on this form will be forwarded to your adviser, program director and site supervisor for verification. By typing your name below and submitting this form, you agree to the following statement:

My adviser and program director have given permission for me to participate in this internship/teaching opportunity. I understand that it is my responsibility to keep the agreement that I have with my adviser on goals and expectations in the laboratory and/or toward my degree during this experience. I also agree to fulfill my responsibilities at the internship/teaching site as described. I will consult with Career Services regarding any concerns with my internship/teaching experience.


Contact Information