Internship Agreement

Student ID (A0...) *

Full Name *

Contact Phone Number *

Texas State Email (full address including @txstate.edu) *

Degree Program *

Public Health

Clinical Exercise Science

Health & Fitness Management

Planned Semester of Internship *

Spring 2024

Summer 2024

Fall 2024

Intern Responsibilities Statements *

Read the following statements and check each box if you agree:

I agree to complete 400 (for ESS 4660/4661)/480 (for PH 4660) /240 (for PH 4360) contact hours. I understand that this is a full-time internship experience and that working an additional job is not encouraged. A maximum of 40 hours/week will need to be dedicated to this internship to complete the required hours. I will not work over 40 hours in a week at the internship without prior approval by my University Internship Supervisor (course faculty).

I understand that hours may begin on the first day of class. Hours completed prior to that time will not be counted toward the 400/480 hours without prior written consent from the internship instructor.

I will adhere to professional ethics while engaged in the internship program. The agency/site/organization may terminate the internship of any student whose performance or conduct is unsatisfactory. If the internship is terminated, the student must contact the University Internship Director within 48 hours as to the reason for termination of the internship. The University Internship Director will decide the future placement (or course withdrawal) of that intern based on the reason for termination.

Agency Name *

Agency Contact Person Name *

Title *

Agency Contact Email Address: *

Agency Contact Person Phone Number *

Agency Address: *

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