Internship Proposal Form - University of Maine Cooperative Extension

Your Name*

First Last

Your Email*

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Your Supervisor's Name*

First Last

Your Supervisor's Email*

Basic Internship Information

Name of Internship*

Where/location of the internship*

(For example: office location, field location, city/town, etc.)

Is there office space/support for an intern if needed?*

Yes
No

If yes, where is the space located or who would provide office support?*

Is there computer/technology access available if needed?*

Yes
No

Proposed Start date for the internship*

Proposed End date for the internship*

Who will supervise the intern?*

Does the supervisor have experience supervising an intern or college student worker?*

Yes
No

If no, what help and support will be needed?*

Who will approve time for the intern?*

Do you have a student already identified for this internship?*

Yes
No

If no, how will you help advertise this internship?*

If you already have a student for this internship, will this internship be for academic credit?

Yes
No

What will the hourly rate be for this internship?*

(The minimum hourly rate is $12.75)

What chartfield will be used for the internship?*

Goals and Objectives

Why do you want to host an intern?*

What are the benefits to a student with this internship?*

What is the overarching goal of the Internship?*

What are the three main learning objectives?*

The objectives need to be realistic, achievable, and represent a substantive learning experience for student interns. For example: Conduct outreach with current and prospective stakeholders by using various methods of communication.

What are the learning tasks for the 3 main learning objectives listed above?

For example, the learning task that would support the example of the learning objective given in the previous question could be: The intern will research potential stakeholders; conduct a one-week marketing marathon, and produce a summary of results.

What’s the Research Component?*

Please outline the research project as it ties to the project goals.

Training and Activities

Describe the specific activities/tasks/responsibilities expected of the intern?*

What networking opportunities will you offer the intern?*

(i.e. connecting with other extension interns, connecting with other extension staff, connecting with key stakeholders you work with, etc.)

Outline the site-specific training plan for the intern?*

Outline your supervision support plan for the intern?*

Timeframe and Expectations

What is the total time commitment of the intern for the internship?*

(How many hours per week?)

What is the weekly schedule?*

What are the specific skills or abilities expected of the intern?*

Are there things the intern will be expected to learn? If so, how will the intern gain these skills?*

What are the work environment expectations of the intern?*

(ie., working in an office, out in the field, any special safety protocols, background check requirement, etc.)

Do you have a learning contract for this internship?*

Note: A learning contract is required if the intern will be receiving academic credit.

Yes
No
To be completed when Intern is assigned

Evaluation Process

A formal evaluation is expected of each intern. What is your process for evaluation?*

How do you plan to provide mentoring to an intern to help identify their strengths?*

How will you conduct an exit interview for the Intern?*

Do you have questions for the exit interview?*

Yes
No

Email

This field is for validation purposes and should be left unchanged.