ENVS 2991/3991 Internship Proposal Student Information First Name * Last Name * Student Email * Faculty Mentor Information ENVS Faculty Mentor * Your faculty mentor will help guide the learning experience. The two of you will decide on deliverables for assessment. Faculty Mentor Email Address * I have consulted with the listed faculty mentor about advising my internship. * Yes An email will be sent to your advisor for verification when this form is submitted. Organization Information Sponsoring Organization * Sponsoring Supervisor * Sponsoring Supervisor Email * I have consulted with the listed supervisor and they have agreed to sponsor my internship. * Yes An email will be sent to the supervisor for verification when this form is submitted. University policy on internships In order to be in compliance with University policy on internships, I have shared the following forms with my site supervisor and they have signed them. (The forms can be found here and here. Your site supervisor can indicate their agreement with these documents using the form available at go.uvm.edu/internforms.) I realize I may not proceed with my internship until these forms have been signed and submitted. It is my responsibility to see that they are. * Yes Additional Information This internship will take place during 201920202021 Fall Fall - 2019 Fall - 2020 Fall - 2021 Spring Spring - 2019 Spring - 2020 Spring - 2021 Summer Summer - 2019 Summer - 2020 Summer - 2021 Number of credits (1 credit hour = 45 hours of internship work) * 1 credit (45 hours)2 credits (90 hours)3 credits (135 hours)4 credits (180 hours)5 credits (225 hours)6 credits (270 hours)7 credits (315 hours)8 credits (360 hours)9 credits (405 hours) Describe and connect previous academic coursework to the proposed internship. * Max character limit = 4000 Describe previous lived, work and internship experiences related to the proposed internship. * Max character limit = 4000 Describe specific tasks, skills, or projects that will be part of the internship. * Max character limit = 4000 Describe the goals and learning objectives of the proposed internship. * Max character limit = 4000 COVID Checklist for Non-Clinical Student Placements COVID-19 is a highly contagious virus. It is possible to develop and contract the COVID-19 disease even when individuals follow all of the safety precautions recommended by the CDC, the State of Vermont, and UVM. The University is following all public health guidelines to reduce the spread of infection, however, by engaging in off-campus internships, clinical placements, or other practica (collectively “placements”), students can never be completely shielded from all risk of exposure or illness caused by COVID-19 or other infections. All students engaging in fall 2020 placements must attest to the following as a prerequisite to participation: * I understand that I am bound by the Green and Gold Promise while participating in an off-campus placement as if I was physically on campus. I have completed the UVM Required COVID-19 Training in Blackboard and have submitted a certificate of completion to my academic supervisor. I have reviewed the most current quarantine guidelines provided by the Vermont Department of Health, and for out of state placements the Department of Health in that state, and will comply at all times during the term of my placement. I understand that my activities both during and outside of the hours spent at the placement site may impact my ability to meet health and safety guidelines. Specifically, while not at the placement site, I am encouraged to avoid unnecessary travel and practice physical distancing to ensure my ability to complete the placement experience is not unnecessarily compromised. I understand that I am required to participate in appropriate orientation provided by the placement site covering, at a minimum, health and safety protocols specific to the placement environment. I understand that whenever I am at the placement site, I am required to comply with site policies and protocols about health and safety, including use of personal protective equipment, appropriate hygiene, physical distancing, health monitoring, and reporting. I understand that use of personal protective equipment (PPE) may be necessary based on placement site requirements. The placement site and UVM will work cooperatively to provide me with necessary PPE. I may, however, be required to provide my own basic facial covering. I understand that students are encouraged to engage in placements via remote means, if possible. For placements that cannot be completed remotely, and are required program components, UVM will work with me if I am not comfortable or able to complete on-site placement due to health and safety considerations. I understand that, in some cases, this could result in a delay of my academic progress. I understand that I am required to immediately share any health or safety concerns about placement site protocols or conditions with my academic supervisor, and I am never required to enter a placement site or engage in activities when I have such concerns. I am required to report any injury sustained or infectious disease exposure to UVM Risk Management, my academic supervisor, and as may be required by the terms of the Green and Gold Promise. Type Your Name to Sign * New date * Year Year20222023202420252026 Month MonthJanFebMarAprMayJunJulAugSepOctNovDec Day Day12345678910111213141516171819202122232425262728293031 CAPTCHAThis question is for testing whether or not you are a human visitor and to prevent automated spam submissions. Math question * 8 + 4 = Solve this simple math problem and enter the result. E.g. for 1+3, enter 4.
