Fall 2001 Criminal Justice Internship

UWF Department of Criminology and Criminal Justice

Internship Placement Form and Contract

In the Pensacola area: In the Fort Walton Beach area:

Paula Lannes, MS Dr. Kathrine Johnson

Criminal Justice Internship Coordinator Criminal Justice Internship Coordinator

850-474-2365 850-863-6588

Please type or print clearly. This form must be completed IN FULL and returned to Internship Coordinator after initial interview with internship site, or once at the beginning of the internship.

The purpose of the Internship is to give students the opportunity to apply their education to actual work situations. For Criminology and Criminal Justice students, the student intern works under the supervision of the criminal justice professional. For all other majors, the student intern works under the supervision of an appropriate professional.

SECTION A. Student Intern Information

Name of Intern: ______Mailing Address: ______

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Phone: ______E-mail: ______

Student agrees:

1. To complete 160/320 clock hours at the placement site by the last day of classes for a 3/6 credit-hour internship (a different form is required if this does not apply to you).

2. To abide by the rules, regulations, and policies of the placement organization.

3. To inform Internship Coordinator of any changes to the above contact information or any changes pertaining to the internship.

4. To maintain a professional attitude toward work and the work environment.

5. To assume responsibility for punctual and accurate preparation of reports, records, and other materials requested by the Internship Coordinator.

6. Submit Internship portfolio documents, as described in the syllabus, into eLearning by the last day of class.

Waiver and Release:

I am aware that risks may be involved and agree that neither:(i) the organization/agency (listed in Section B); nor (ii) the University of West Florida or any officer, employee, or agent thereof (the “Releasees”) is responsible for any harm that may result from activities related in any way to the Internship or in transit to or from the Internship. I agree to indemnify and hold harmless the Releasees for any loss, liability, damage, or costs that may occur as a result of my participation in said activity. I understand that the University does not maintain any insurance policy covering any circumstance arising from my participation in this activity or any event related to that participation.

I certify that I have carefully read and understand the above agreement, waiver, and release, and have agreed to the terms thereof as my own voluntary act and deed, and further certify that all information I have provided is correct:

Signature of Intern: ______Date: ______

SECTION B. Placement Organization/Agency Information and Intern Supervisor Information

Placement Organization: ______Mailing Address:______

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On-Site Supervisor(s)______Phone: ______

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E-mail: ______Fax: ______

Internship On-SiteSupervisor agrees:

1. To aid and support the student in his/her efforts to complete assigned tasks.

2. To allow time for field instruction as well as formal and informal conferences to enhance constructive learning, self-awareness, and self-evaluation.

3. To provide feedback to the student regarding his/her performance at the placement organization.

Signature of Intern Supervisor: ______Date:______

SECTION C: Role of Intern InOrganization (To be completed by the InternOn-Site Supervisor whose signature appears above).

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