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AttachedistheinternshippacketbeginningFall2016forANEQ487AorB(AnimalorEquineScience).Componentsofthepacketneedtobecompletedby:InternSiteSupervisorAdvisorInternshipCoordinatorAllitemsMUSTbecompleteandsubmittedtotheinternshipcoordinatorPRIORtoastudentenrollingintheclassORbeginningtheinternshipwork.Atthecompletionoftheinternshipafinalreportorprojectisrequired.Thedirectionscanbefoundattheendofthispacket.Pleasenotethatasaninternyouareresponsibleforinitiatingcontactwithasitethatyoufeelenhancesyoureducationalexperience;internshipcoordinators,advisorsandfacultyareheretoassistwithanyquestionsortoofferadditionalresources.Roughly45hoursof“work”isrequiredpercreditseeking.PleasecontactTiare(Equine)tiare.santisteven@colostate.eduorBeka(Animal)beka.crocket@colostate.eduwithanyquestions.Thisagreementmustbefilledoutcompletely,signed,andreturnedtotheAnimalorEquineScienceInternshipCoordinatoratColoradoStateUniversitybeforeyoustartyourinternshipinorderforColoradoStateUniversity(CSU)tosponsoryourinternship.ThissponsorshipincludesconsiderationforWorker'sCompensationinsurancecoveragebyCSUfornon-paidinternships.CleardefinitionoftheHostsite’sexpectationsandthestudent'slearningobjectiveswillmaximizetheinternshipexperienceforbothpartiesThestudent,hostsite,facultysponsor,andinternshipadvisoragreetoassumetheresponsibilitiesoutlinedbelowforthedurationofthestudent'sinternshipplacement.NOTE:Employer,Faculty,andinternshipadvisorsignaturesarerequiredpriortothestartofinternships.

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Startdate(mm/dd/xxxx)_____________________Enddate(mm/dd/xxxx)____________________________

Academicsemester___Fall___Spring___SummerCourse#_____________________________________

PositionTitle_________________________________________

Internshiptype:____Creditonly#credits______Unpaid?Yes/no

____Credit&Paid#credits______Payrate/hour$_________#ofhours/week

SPONSORINGACADEMICDEPARTMENT

STUDENTINFORMATION

INTERNSHIPINFORMATION

AcademicDepartment:AnimalSciences/EquineSciences Dean/Chair:KevinPond

InternshipCoordinator_________________________________Ph.______________________________________

CampusAddress:Email:____________________________________

OnCampusSupervisorand/orAdvisor(bothrequiredforEquine)__________________________________

Ph.________________________________________

CampusAddress: Email:____________________________________

FirstName_______________________LastName_______________________StudentID#__________________

Phone__________________________Cell#______________________Email_____________________________

Address_______________________________________________________________________________________

City__________________________________State________________________ZipCode__________________

Major(s)______________________________________Degree_______________YearinSchool_____________

Academiccourseregisteredinforinternship____________________Credithours______________Semester_____

EmergencyContact___________________________Ph______________________Relationship______________

EmergencyContact___________________________Ph______________________Relationship______________

ListanyallergiesorspecialmedicalconditionsyouwouldliketheHostSitetobeawareof____________________________

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HOSTSITEINFORMATION

Organization:__________________________________________________________________________________

Address______________________________________________________________________________________

City_____________________________________State________________________Zip_____________________

SiteSupervisor________________________________________PositionwithinOrganization:_______________

Ph_______________________________________________Email:______________________________________

PersonwithinOrganizationwhohasauthoritytoauthorizereceiptofinternships___________________________

Ph______________________________________________Email_______________________________________

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INTERNSHIPDESCRIPTIONLearningAgreement

TheSiteSupervisorandstudentshouldcompletethissectiontogether.Describethenatureof thepositionand intern’sduties. Listspecificprojectsortasksaswellastherequiredskills.Attachajobdescriptionifavailable.

IdentifyqualificationsneededforthepositionIdentifyanyrequiredskillsandphysicalrequirements

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INTERNSHIPLEARNINGOBJECTIVES1. Whatarethelearningobjectivesoftheinternship?2. Howwillthisexperiencedemonstratethestudents’knowledgeofcourseworkconcepts?3. Howdoesthisinternshipcontributetothestudentabilitytoenteracareerwithexperience?4. List 3-8 specific educational, professional, and personal goals that are observable, measurable, and able to be

evaluatedbythefacultysponsorandsitesupervisor.Beginbulletlistwithwordssuchas“assistwith,”“learnhowto,”“expandknowledgeof,”“understandtheprocessof.”.

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INTERNSHIPCONSIDERATIONSProvidethefollowinginformation1. Locationoftheactivities,e.g.outdoors,laboratories,off-sitelocations2. Potentialhazardousandexposures,ifany,andtheirconsequences.

Thisincludesexposuretomaterialsandactivities,forexample,animal,biological,chemical,physicalorradiologicalhazards.

3. Identifyanysafetyequipmentandtrainingrequirements.

4. Outlinealltrainingrequirementsincludingsafetytrainingneededwhoisresponsibleforeachactionitem

5. Vaccinations,ifanythatarerequiredinordertoparticipatedintheoutlinedinternshipandpersonpaying.6. Identifythecommunicationtreetoensureinternshipsite,familyandCSUarenotifiedintheeventofanemergency.

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EQUINESCIENCESONCAMPUSSUPERVISORRESPONSIBILITIES:

• Assistthestudentinformulatingconciseandclearlearningobjectivesfortheinternship.• Reviewthepositiondescriptionandensurethatitmeetslearningobjectives• Determine and discuss how the proposed internship is relevant to the student's educational objectives and

meritsacademiccredit.

• Determineacademicassignments,monitorstudentprogress,andprovidefinalevaluation.• Keepincontactwithinternsthroughouttheinternshipinordertoappraiseprogressandaddressconcernsand

questions

Ihavereviewedandunderstandtheinternshipdescription,jobannouncement,rolesandresponsibilitiesofthepertinentparties.IaminagreementandacceptanceofmyRolesandResponsibilitiesOnCampusSupervisorSignature__________________________________________________________________ PrintedName Signature Date

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ADVISORRESPONSIBILITIES:• Verifythestudentmeetsdepartmentalrequirementsforaninternship.• Assistthestudentinformulatingconciseandclearlearningobjectivesfortheinternship.• Reviewthepositiondescriptionandensurethatitmeetslearningobjectives• Determine and discuss how the proposed internship is relevant to the student's educational objectives and

meritsacademiccredit.

Ihavereviewedandunderstandtheinternshipdescription,jobannouncement,rolesandresponsibilitiesofthepertinentparties.IaminagreementandacceptanceofmyRolesandResponsibilitiesAdvisorSignature__________________________________________________________________

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INTERNSHIPCOORDINATORRESPONSIBILITIES:• Reviewthestudent'seligibilityforparticipatinginanacademicinternship(GPA,prerequisites,etc.)

• Maintaincopyofhostsite’scertificateofinsurance(ifrequired.)

• Maintainacopyofsafetytraininggiven,(ifapplicable)

• Maintainacopyofallagreementsbetweenthepartiesofthisinternship

• Actasprimaryliaisonbetweenthestudent,thehostorganization,andthefaculty

• ReviewtheLearningAgreementforcompletenessandaccuracyofinformation.

• Administerinternshipevaluationprocessforallparties.

• EnsurethatallAgreementsanddocumentsareinplacepriortothestartoftheinternship

• Serve as liaison for any issues that arise during an internship – e.g. workplace conflicts or

problems with supervisors or co-workers, injuries, not getting the agreed onsite hours,

ensuringtheopportunitytofulfilltherequirementsoftheinternship–numberofworkhours,

learninggoals,etc.

• Conductsitevisitswithinternstudentandsitesupervisor

• Collectemployer’sfinalevaluation

• Assigngrade

Ihavereviewedandunderstandtheinternshipdescription,jobannouncement,rolesandresponsibilitiesofthepertinentparties.IaminagreementandacceptanceofmyRolesandResponsibilitiesInternshipCoordinator____________________________________________________________________ PrintedNameSignatureDate

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HOSTSITERESPONSIBILITIESVerifythepositionanddutiesmeettheUniversityInternshipscriteria• Completeajobdescriptionthatincludes;

o LearningObjects&Goalso Professionsareastheinternwillgainexposuretoo Expectedskillstolearno Dutiesandresponsibilitiesofinterno Resources, equipment, and facilities provided by the host employer that support the

learningobjectives/goals.o Specialqualificationsrequiredfortheposition.o Specialtrainingorconsiderationsrequiredofthepositiono Datesoninternshipo Ifaconfidentialityagreementisrequired,stateditinthejobdescriptionuponposting.

• Encourage professionalism by assisting student in developing communication, interpersonal,decision-making,andotherskills

• Provideopportunitiesforincreasingresponsibility;keepingstudentdirectedtowardaccomplishinghis/herlearningobjectives

• Discloseallagreementsastudentwillbeaskedtosignintheinternshipdescription

*studentscannotsignhold-harmlessagreementswithoutCSU’sGeneralCounselreview

• Provideanorientation,anyprecautionarysafetyinstructions,trainingandongoingsupervisionforassignedduties.

• Provideasafeworkenvironment

• ProvidestudentandCSUstaffwithinformationregardinganySafetyConsiderations.o Identifytherisksofactivitiestheinternmaybeinvolvedinandidentifytherequiredsafety

training for any tools, computers, specialized equipment, vehicles, physical activities,hazardous chemicals, biologicals or radioactive materials, etc. that are part of theiractivities. Document training and include a signature that the trainingwas received andunderstood

• ProvideadequatesafetytrainingandprovideallPersonalProtectionEquipmenttothestudentandhavethemproperlyfittedpriortothestartofinternship.

• ProvideCSUwithcopiesofsafetyandtraininginstructions• Maintainopenchannelofcommunicationwithregularmeetings• Keepinternshipdutieswithinthescopeoutlined.• Completealltrainingdocumentationsafinalevaluation.

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• If the student is paid, understand the responsibility for providing worker’s compensation and

liability insurance in accordance with Colorado State Law, and provide said coverage ColoradoRevisedStatute8-40-302(7)(b)

o Complywith federalandstate lawsprohibitingdiscriminationonthebasisof race,color,sexualorientation,nationalorigin,sex,and/ordisability

o ComplywithFederalLaborStandardsAct(FLSA)• ProvideproofofWorkers’CompensationInsuranceforallpaidinternships

• Complywith Federal Laws prohibiting discrimination on the basis of race, color, national origin,

sex,disability,and/ormilitarystatus.• AnyinsurancerequirementsofColoradoStateUniversity,needstobeapprovedandagreedtoby

theOfficeofRiskManagement&Insurancepriortoplacements.• NotifyCSUinatimelymannerifanyproblemsariseduringtheinternshipplacement.• Completeafinalwrittenevaluationofthestudent'sperformance• Donothavethestudentsignanywaivershold-harmlessagreementsorotheragreementswithoutCSU’swritten

consent

• Addinternunderbusinessvehicleinsurance,ifemployeeisexpectedtooperatebusinessvehicles.

• Staywithinthehoursoutlinedintheinternshiplearningagreement.

Thisagreementdoesnotreleasethehostsitefromanyliabilityactionthatmaybetakenagainstthemfornegligenceofsafetyorworkplacepractices.I have reviewed and understand the internship description, job announcement, roles and responsibilities of thepertinentparties.IaminagreementandacceptanceofmyRolesandResponsibilitiesSiteSupervisor_________________________________________________________________________ PrintedNameSignatureDateBusinessOwner________________________________________________________________________

PrintedNameSignatureDate

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INTERN/STUDENTRESPONSIBILITIES• Registerhis/herinternshipwiththeinternshipcoordinatoroftheAnimal/EquineDepartment,

registerforcourse#_____ANEQ487A(Animal)orANEQ487B(Equine)andsubmitaLearningAgreementforapprovalpriortothestartdateoftheinternship

• Review the internship position description to ensure that itmeets the criteria for an internshipwithinhis/heracademicstudy

• Implementtasksthatfulfillthejobdescriptionandlearningobjects• Complete all pre intern requirements that are listed in the job description and in the learning

agreement• Approachinternship inaprofessionalmannerthat isguidedbycourtesy,adesireto learn,anda

willingnesstoreceivefeedbackforimprovement• Signupandcompletetherequirednumberofhoursforthecreditshoursoutlinedintheinternship

selected• Act inaresponsibleandappropriatemanner inaccordancewiththerulesandregulationsofthe

organization• CompleteallassignmentsoutlinedintheInternshipdescriptionsandSignedLearningAgreement.• Observeallsafetyrules• Fulfilltasksandresponsibilitiesassignedbyyoursite/hostsupervisorandoutlinedinthisLearningAgreement.• Conduct yourself in an ethical and professional manner, acting as a positive representative of Colorado State

University

• Notify your faculty sponsor in a timely manner of any changes to this Learning Agreement or if any problemsdevelopduringtheinternship.

• Understandthatthenumberofcredithourslistedinthisagreementwillbeaddedtoyourcoursescheduleandthat

youwillbechargedtheappropriatetuitionforthesecredits• This is a variable credit course and YOU are responsible for selecting the appropriate number of credits

basedonthelearningagreement

• Completeallassignmentsoutlinedinthisagreement.• Completetheevaluationofyourinternshipexperience

• Secureallvaccinations,insurances,trainingandequipmentrequiredandoutlinedininternshipdescriptionIhavereviewedandunderstandtheinternshipdescription,jobannouncement,rolesandresponsibilitiesofthepertinentparties.IaminagreementandacceptanceofmyRolesandResponsibilitiesStudent_______________________________________________________________________________

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*StudentsmustbeenrolledinANEQ487thesemestertheinternshipiscompleted!PurposeofReportEachstudentistosubmitafinalreporttohis/herInternshipCoordinatorandinEquineSciencestheOnCampusSupervisor.ThepurposeofthisfinalreportistosummarizetheinternshipexperiencefortheInternshipCoordinatorandforothers,includingfuturestudentsinterestedinasimilarinternship.Generally,thereportisnotdistributedtothecooperator.Neworuniqueexperiencesshouldbeemphasized,particularlythoseconcerningtheobjectivesoftheinternship.Thereportgivesthestudentanopportunitytowritehis/herreflectionsontheprogramandexpressthosethingsthathavethemostmeaningnowthatthisexperienceiscompleted.PreparationManystudentskeepcopiesoftheirweeklyreportsormakealogoftheprincipleexperiencesduringtheinternshipandusethesenotestowritetheirfinalreport.Somestudentsbeginthewritingoftheirreportduringthelasttwoorthreeweeksoftheprogramandtrytocompleteitduringthefinalweekoftheinternship.Suchplanningwillgivethestudentachancetoaskfurtherquestionsorclarifypointsthatmaynotbewellunderstoodwhilestillinthepresenceofthecooperator.Themajoradvantageofwrappingupthereportwhilestillontheinternshipisgettingitcompletedbeforereturningtocampus.Delayedreportsbecomeanaddedburden.AnIncompletegradeisgivenincaseswherethefinalreportandthecooperatorandstudentevaluationsarenotinthehandsoftheInternshipCoordinatorby“finals”week.Format,ContentandLengthThereportshouldincludean“introduction,”a“discussion”ofthedifferentaspectsoftheinternshipanda“conclusion”.Theintroductionwillserveasanopeningstatementandshouldincludewhereandwithwhomtheinternshipwasaccomplishedandtheobjectivesofthelearningexperience.Acknowledgementstothecooperatorshouldbeindicatedintheintroduction.Themajorcontentofthereportshouldrelatethoseitemsthatseemofprimeimportancetostudentsintermsofwhatwaslearned,uniqueexperiencesgainedandnewmethodologyobserved.Thispartofthereportprovidestheopportunitytowriteconsiderabledetailaboutafacetoftheinternshipexperiencethatwasmosteducationalandmeaningful.Arehashoftheweeklyreportsshouldbeavoided.Thelastportionshouldincludethestudent’sconclusionsabouttheexperienceandanyrecommendationsthatshouldbepassedonforthebenefitofthenextstudentandtheInternshipCoordinator.Dependingonhowmanycreditsthestudentisworkingtoward,thelengthofthetypedreportshouldbebetweenthree(3)andtwenty(20)pages,doublespaced.Typically,thepaperis2-3pagespercredit.Pictures,brochures,etc.areencouraged.Careshouldbegiventocorrectspelling,punctuationandgrammar.AnimalSciencestudentsmayelecttodoapresentationinsteadofapaper.Consultwiththeinternshipcoordinatorforspecificdirectionsontheserequirements.IftheInternshipCoordinatorfindsthepapertobeunsatisfactory,theywillreturnittothestudentforcorrections.Agradewillnotbegivenuntilthesecorrectionsaremade.

Animal/EquineScienceInternshipREADTHISDOCUMENTCOMPLETELYBEFORESIGNING.ITSEFFECTISTORELEASECOLORADOSTATEUNIVERSITY,ITSGOVERNINGBOARD,ANDTHESTATEOFCOLORADOFROMANYLIABILITYRESULTINGFROMYOURPARTICIPATIONINTHEACTIVITIESDESCRIBEDBELOW,ANDTOWAIVEALLCLAIMSFORDAMAGESORLOSSESAGAINSTTHEUNIVERSITYWHICHMAYARISEFROMSUCHACTIVITIESEVENIFTHEYRESULTFROMNEGLIGENCE.

Guidelines for the Final Report of Internship Experience

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RELEASEFROMRESPONSIBILITY,ASSUMPTIONOFRISK,ANDWAIVERPARTICIPANT’SFULLNAME:______________________________DATEOFBIRTH(MO/DAY/YR):__________________________ADDRESS:__________________________________________________________________________________LOCATIONOFACTIVITY(IES):________________________________DATE(S)OFACTIVITY(IES):STARTDATE:

ENDDATE:

Checkone: CSUSTUDENTDESCRIPTION OF ACTIVITIES: Animal Science internship with __________________________________ which may includeexposure toanimals, andanimalsareunpredictable. Itmayalsoexposeme tohazardousmaterials, equipmentand situationsthatcouldbedangerous.INSURANCEINFORMATION:IFSTUDENT:IamawarethatasastudentofColoradoStateUniversity,Icanpurchaseaccidentinsurance,eitherthroughColoradoStateUniversity (ifavailable)or throughanother insurancecarrieroragent,and (checkone) have havenotexercisedmyrighttodoso.NAMEOFINSURANCECARRIER:_______________________________ POLICYNUMBER:_____________I,theundersignedparticipant,exercisingmyownfreechoicetoparticipatevoluntarilyintheactivitiesdescribedabove,andpromisingtotakeduecareduringsuchparticipation,herebyacknowledgethatIhavebeeninformedofthenatureoftheactivitiesandthatIamawareofthehazardsand riskswhichmaybeassociatedwithmyparticipation in theabove-namedactivities, including the risksofbodily injury,deathordamage topropertywhichmay occur from known or unknown causes. I understand, accept, and assume all such hazards and risks, andwaive all claimsagainsttheStateofColorado,TheBoardofGovernorsoftheColoradoStateUniversitySystem,andColoradoStateUniversity,andotherpersonsasset forthabove. I understand that I amsolely responsible forany costsarisingoutofanybodily injuryorpropertydamage that Imay sustainthroughmyparticipationinnormalorunusualactsassociatedwiththeabove-namedactivities,regardlessofwhosefaultmaybethecauseofmyinjuriesordamages,EVEN IFCAUSEDBYCARELESSNESSORNEGLIGENCE,so longas theconductwhichcausedthe injuriesordamageswasnotgrosslynegligent,orwillfulandwanton.Further,IherebyindemnifyandholdharmlessTheBoardofGovernorsoftheColoradoStateUniversitySystemandColoradoStateUniversity,andtheirmembers,officers,agents,employees,andanyotherpersonsorentitiesactingontheirbehalf,andthesuccessorsandassignsforanyandalloftheaforementionedpersonsandentities,againstanyandallclaims,demands,andcausesofactionwhatsoever,whetherpresentlyknownorunknown,ofanypersonwhosuffersanyinjury,disability,deathorotherharm,topersonorpropertyorboth,asaresultofmyparticipationinand/orpresenceattheabovelistedactivities.Ihavehadsufficienttimetoreviewandseekexplanationoftheprovisionscontainedabove,havecarefullyreadthem,understandthemfully,andagreetobeboundbythem.Aftercarefuldeliberation,IvoluntarilygivemyconsentandagreetothisReleaseFromResponsibility,AssumptionofRisk,andWaiver.IHAVEREAD,UNDERSTOODANDAGREEDTOTHEABOVETERMSTHIS

DAYOF

,20

.SignatureofParticipantwhoseprintednameappearsabove: Signature(date) Witnessover18yearsofage(ParentorGuardianmustsignin thepresenceoftheWitnessIfparticipantisundertheageof18,hisorherparentorlegalguardianmustalsosign:I,(printedname)___________________________________________,amtheparentorlegalguardianoftheparticipantwhohassignedabove.IhavereadandIunderstandtheprovisionsofthisdocument,andactingonbehalfoftheparticipant,Iconsenttotheparticipanttakingpartintheactivitiesdescribedabove,andIfullyenterintoandagreetotheaboveReleaseFromResponsibility,AssumptionofRisk,andWaiverasauthorizedpursuanttoC.R.S.section13-22-107._________________________________ _______________________________________