HSB Internship Placement Agreement.pdf - HSB Internship...

HSB Internship Capstone PLACEMENT AGREEMENT
Prior to completing this document, please provide the internship sponsor with the
Program Welcome Letter and Workers’ Compensation Information sheet.
Student Name Student ID #
Address City Zip
Telephone Email
Employer/Sponsor Company Name
Name of Supervisor Supervisor Position
Site Address City Zip
Telephone Email
The above student, completing an Internship with the above organization, will receive Boulder
Valley School District credits for this experience. A signed copy of this form will be returned to you
indicating acceptance of these arrangements.
School Teacher/Coordinator
Course Section Fall Or Spring Year Program
Duration of Internship Start Date Anticipated End Date
Industry/Type of work the student will be performing:
Remuneration, (if applicable) $ per hour. Other compensation benefits student will
receive, if any:
**Please note: if student interns are being paid, liability insurance while on site will be the
responsibility of the employer. If student interns are unpaid, BVSD Liability insurance will cover the
student intern.**
Student agrees to :
● Follow the employer’s work and job conduct rules.
● Report to Internship promptly and regularly and notify the Employer at once if illness or an emergency
prevents the student from reporting to work.