Intern Request Form

This form should be completed by the Mentor and submitted at least 2 weeks prior to the intern's arrival date.

Today's Date:*

Date

Intern Primary Supervisor:*

First NameLast Name

Email*

You must be a Bigelow employee

Secondary Supervisor (if applicable):

First NameLast Name

Email

example@example.com

Intern name (if known):

First NameLast Name

Intern Email (if known):

example@bigelow.org

Anticipated Start Date:*

Date

Anticipated End Date:*

Date

For summer interns: Will this intern participate in REU programming? (This option is typically available even if the intern is not funded by the NSF REU grant.)*

YesNoN/A (Not a summer intern)

Will the intern be paid?*

PaidUnpaid

If paid:

What is the anticipated total stipend?*

What project will provide the stipend?*

Will the intern need institutional housing?*

YesNo

If yes: what project will pay for housing?*

Will the intern be diving?*

YesNo

If yes please explain

Will he/she be participating in any research cruises or field work (besides the day cruise associated with the REU program)?*

YesNo

Describe

Will he/she be using any radioisotopes?*

YesNo

If yes, isotope usage will be perfomed at:

BigelowSeaOther

Will he/she be participating in a project that includes the use of genetic manipulation?*

YesNo

If yes please describe

Will he/she be participating in a project that involves biosafety level (BSL) 2 or 2+ organisms?*

YesNo

If yes please explain

Is the BSL or genetically modified organism going to be worked with at Bigelow or elsewhere*

BigelowOffsite

If answer to above was not Bigelow, please explain.

If organisms are being modified, will they be shipped elsewhere?*

YesNo

If yes above please explain

Will he/she be participating in a project that generates toxic or hazardous compounds and/or products?*

YesNo

If yes please explain

Will he/she be participating in a project that requires approval of the Institutional Animal Care and Use Committee (IACUC)?*

YesNo

If yes please explain

Please explain the purpose of the internship. This information is used to determine whether the intern is entitled to minimum wages and overtime pay under the FLSA.

Learning Objectives: What will the intern learn during his/her time at Bigelow?*

Activities: Describe the duties and responsibilities of the intern.*

Evaluation: How will the intern be evaluated (final report, meeting, etc)?*

Supervisor Signature (Type your name in this box)*

Dive Safety Officer Approval

Finance Officer Approval

Education Office Approval

Safety Officer Approval

IBC Approval

Radiation Officer Approval

IACUC Approval

Required

Once this form is approved, the Education Coordinator will enter the information into the Master Intern List. Once an individual is awarded the internship, the Education Coordinator will create an internship agreement letter to send to the intern. The Education Coordinator will then send pre-arrival informations to the intern, including payroll forms (if needed), student handbook, and other student forms.

Please verify that you are human*

INTERN REQUEST FORM

Other Considerations