Internship-Teaching Consent Form

Doctoral students: In order to participate in an internship or teaching experience, doctoral students must be post-comprehensive or complete the experience during the summer. Any exceptions to this must be approved by the student’s program director and PI.
 
Graduate Assistantships: If you are on a graduate assistantship and accept a paid internship, your graduate assistantship stipend may be adjusted or waived for the semester in which you are completing the internship.
 
Graduate Fellowships: If you are on a graduate fellowship (T32, F31, etc.), please contact Graduate Education BEFORE accepting an internship offer. Many fellowships may limit the time permitted to complete an internship. Doctoral students should be aware of the guidelines and percentage of effort permitted by the terms of the fellowship.

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

Internship/teaching experiences encompass all supplemental, learning opportunities including, but not limited to, internal and external internship, off-campus teaching, off-campus research, special project, and job shadowing/externship experiences.
Student/Academic Information




Must be @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 internship/teaching 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 my research lab/department 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 Graduate Career Services regarding any concerns with my internship/teaching experience.


Contact Information