New Internship Provider Submission Form

Internship Submission Form
New Internship Provider

(To be used by Newly Admitted Students, Current Students who are not continuing with their current provider, ITU Alumni starting another degree program at ITU, and students who have not participated in an Internship with ITU)

Student Information

Full Name*

First NameMiddle NameLast Name

Student ID Number*

E-mail Address (student email address)*

example@students.itu.edu

Degree Program*

Current Residential Address (Any change to this address must be reported to ITU within 10 days)*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry

Internship Information

Hours*

Part Time (under 20 hours/week)Full Time (21-40 hours/week)

Internship Provider Name*

EIN (9 digit tax ID number) or E-verify (4-7 digit number)*

Internship Provider Website*

Internship Title*

Is this position paid or unpaid?*

PaidUnpaid

Address of Internship Provider's Headquarters*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry

Supervisor Full Name*

First NameLast Name

Supervisor Phone Number*

Area CodePhone Number

Supervisor E-mail Address*

Please list the same email address used in the Offer Letter.

Human Resources Manager Name*

First NameLast Name

Human Resources Manager Email*

Human Resources Manager Phone Number*

Area CodePhone Number

Additional Information

Are you an international student?*

YesNo

if Yes, Visa Type*

F-1H1BH4 (Authorized EAD)

SEVIS ID Number:*

CPT I-20 Shipping Options*

Pick-upUSPS Standard MailUSPS Express Mail (Additional Fees may apply)

Phone Number*

Area CodePhone Number

Mailing Address: (if different from above)

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry

If you are an H1B student, we recommend that you consult with your lawyer prior to applying for internship. **Students cannot use regular employment as an internship opportunity.

Required Forms and Acknowledgements

Check to make sure you filled out and completed all student sections of the Internship Request Form.

Step 1: Student Section - make sure all parts are filled in correctly and marked

Important:

Save your file as follow: New Internship Provider Request From - Student ID - First/Last Name

i.e.: New Internship Provder Request Form - 12345 Jane Doe

Upload Internship Request Form*

(6 MB Max. PDF only.)

Download New Internship Request Form

New Internship Provider Request Form Acknowledgment*

I acknowledge that I have completed all of the Student Section of my New Internship Provider Request Form

Upload Offer Letter*

(6 MB Max. PDF only. Picture of the form will be accepted.)

Download Sample Offer Letter

Offer Letter Acknowledgment*

I acknowledge that the Offer Letter being uploaded is true and not altered in any way, shape or form and has all of the requirements as indicated above and in the Sample Offer Letter. If required fields are not included or inaccurate my application will be denied.

Check your Internship Cooperative Agreement Form:

Is the person who signed the Cooperative Agreement Form listed in your Offer Letter?
- If you answered Yes, please proceed to upload
- If you answered No, please update your Cooperative Agreement Form with someone who is listed on the Offer Letter, or add the person who signed the Cooperative Agreement to the Offer Letter

Important:

Save your file as follow: Internship Cooperative Agreement Form- Student ID - First Name Last Name

i.e.: Internship Cooperative Agreement Form - 12345 Jane Doe

Upload Internship Cooperative Agreement*

(6 MB Max. PDF only.)

Download Internship Cooperative Agreement Form

Cooperative Agreement Form Acknowledgment*

I acknowledge that I had my Internship Provider sign the Cooperative Agreement Form, and the person who signed the Agreement is also mentioned in my Offer Letter

Are you a New Student to ITU?*

YesNo

Have you previously participated in Internship at ITU:*

YesNo

*If you are a New student seeking a full-time internship at ITU, please attach documentation here showing a prior successful internship or training experience that was part of a U.S. degree program. Documentation may include one of the following:

1) A recommendation letter generated on organizational letterhead from a prior OPT employer noting that the student’s performance was satisfactory during their training. (For all recommendation letters in this category, please also attach a copy of an I-20 displaying your authorization with that specific organization to verify your authorization.).

2) An unofficial transcript from a previously attended U.S. institution of higher education showing a passing grade in an internship course. (Please highlight the specific course(s))

3) A report from the institution’s internship program at a US institution of higher education showing satisfactory performance in cases where academic credit was not involved

Exception allowing full-time internship in the first trimester*

Internship Policy - Click Here to view ITU's Internship Policy.

I have read, understand, and agree to abide by ITU’s Internship Policy.*

I Agree

To the best of my knowledge, I have fulfilled the eligibility requirements to participate in ITU’s Internship program. I understand that if I have not met these requirements, I may be asked to take additional steps to fulfill those requirements or, in some cases, my application may be denied*

I Agree

I understand and acknowledge that an approved internship maybe reduced to half-time if my Term GPA falls below a 3.0 even though my Cumulative GPA is above a 3.0. Furthermore, I understand that if my Cumulative GPA falls below a 3.0, my internship opportunity will be revoked. I acknowledge that if I receive a No Pass (NP) grade for GRN 900 or INT 593 and CFL 591, I may lose eligibility for internship.*

I Agree

I confirm that the offer letter and cooperative agreement attached with this form were both signed by the internship provider. I also understand the provider will receive a confirmation copy of these documents once an internship is approved.*

I Agree

Responsibilities & Assumption of Risk - Release Statement

I acknowledge that my acceptance of an internship offer is a commitment to the university and the provider, and will perform my duties as indicated to the best of my abilities. As internship is credit base, I will register for the appropriate internship course pending departmental approval; pay the appropriate tuition and fees for the credits registered.
I understand that by registering for INT 593, I will be earning credits (only after approval). I understand that I will be charged for this course, as I would any other course taken at ITU.
I agree to inform myself about any rules and/or regulations specific to my work location. I agree to abide by these rules, and I understand that the provider has the right to withdraw the internship opportunity at any time due because of my violation of such rules, disruptive behavior, academic reasons or conduct issues. I understand that this may result in a failing academic grade.
I agree to notify the Internship Coordinator if any disturbing situation should arise at my work location, regardless of its nature.
I understand that I will receive a grade for my participation in the internship program based on the quality and timeliness of submission of a final report.
I understand that ITU and the internship coordinator cannot guarantee the quality of the internship experience as situations beyond their control may arise.
I understand that participation in an internship involves risks that are not limited to traveling to and within, returning from internship locations; foreign political, legal, social and economic conditions; different standards of design, safety and maintenance of buildings, public places and conveyances; and local medical and weather conditions.
I agree to enroll in such medical insurance coverage program as designated by International Technological University for the trimester, unless I opted to waive the insurance as I have my own.

Institutional Arrangement:
I understand that International Technological University (ITU) does not represent or act as an agent for, and cannot control the acts or omissions of, any host employer (provider), transportation carrier, hotel, motel, your organizer or other provider of food, goods or services involved in the internship.
I understand that ITU is not responsible for matters that are beyond its control. I hereby release International Technological University and it's from any injury, loss, damage, accident, delay or expense arising out of any such matters.
Knowing the risks described above, I agree, on behalf of my family, heirs and personal representative(s), to assume all the risks and responsibilities surrounding my participation in the Internship program. To the maximum extent permitted by law, I release, hold harmless and agree to indemnify International Technological University, its Board of Trustees, and its officers, faculty, staff, representatives, volunteers, employees and agents, from and against any present or future claim, loss or liability for injury to person or property which I may suffer, or for which I may be liable to any other person, during my participation in the Internship (including periods in transit to or from any location and/or country where the Internship may be taking place), resulting from any cause including but not limited to ITU, its Trustees', officers', faculties', staffs', representatives', volunteers', employees', or agents' own passive or active negligence or other acts other that fraud, willful misconduct or violation of the law.

I have read, fully understood, and agree to abide by ITU's responsibilities & Assumptions of Risk-Release Statement*

I Agree

Important Note:

Make sure you read and review all forms and submitions to make sure they are complete and correct. All incomplete applications and/or applications with incorrect information will be denied.

International Students Only:

I must recieve, in writing, practicial training work authorization for my internship from the International Student Office (ISO) prior to employment. I may only partcipate in a for-credit internship. This implies that I must register and pay for the appropriate internship course. I understand that I may not begin my internship before, nor extend beyond, the authorized dates on I-20.

Signature*

Date*

MonthDayYear

Email

example@example.com