Student Signature Date. NOTE: Federal law requires the District to monitor online activities of minors. Staff Agreement and Responsibility – (Must be signed if working with students and the network) I understand and will abide by the Fleming County School District’s Acceptable Use Procedures for Network Access and Telephone Usage. I further understand that any violation of the regulations stated in this policy is unethical and may constitute a criminal offense. Should I commit any violation, my access privileges may be revoked, disciplinary action up to and including termination may be taken, and/or appropriate legal action may be pursued. I agree to promote the Acceptable Use Procedures with each of my students. I agree to instruct students on acceptable use of the network and proper network/telephone etiquette. During the times students are assigned to my care, I agree to direct students to acceptable network/telephone resources and monitor their use at all times. Neglect in my responsibility as an instructor could result in disciplinary action. Personnel Name (Please print): School Assignment: Job Title: Signature: Date: Fleming County Schools Access to Electronic Media
Student Signature Date. As the parent or legal guardian of the student signed above, I grant permission for the student to access networked services such as e-mail and the Internet. The District uses software to control access to objectionable material on the Internet and provides supervision of student computer use. However, I understand that some material accessed on the Internet may be objectionable. I accept responsibility for providing the student guidance on Internet access.
Student Signature Date. I am the parent or legal guardian of the Student, have read the complete document “Student Internship Agreement Form” and I am and will be legally responsible for the obligations and acts of the Student, and agree for myself and the Student to be bound by the terms of this Contract.
Student Signature Date. My son/daughter has discussed with me the tutoring component of the A+ Schools Program, and I give my permission for him/her to participate in the required tutoring activities. I understand that my son/daughter is responsible for his/her transportation to and from these activities.
Student Signature Date. Site Supervisor Agreement 1. Provide the student with a challenging and meaningful learning experience as outlined in the internship description. 2. Provide the student with any necessary training and supervision. 3. Communicate with the Career Center during the course of the internship when appropriate. 4. Complete the required two evaluations of the student’s performance (midway through and at the end of internship). 5. Reserve the right to discharge the student for just cause after consultation with Mount St. Mary’s University.
Student Signature Date. Student’s payment obligation under this Contract shall continue notwithstanding any of the following:
Student Signature Date. For students who express a major difference of opinion regarding the results of this report, a supplemental statement may be attached to this report. Indicate if a supplemental statement is attached: YES NO I have reviewed the Field Learning Agreement I and have discussed all the content areas with the student intern. Field Instructor Signature Date COMPETENCY 1: Demonstrate Ethical and Professional Behavior with Client Groups as they Age through the Life Course Measurable Learning Behaviors/Activities
Student Signature Date. Dentist Agreement: I understand my obligation to supervise, direct and evaluate in his/her responsibilities as an EFDA in my practice. I agree to provide him/her with the opportunity to utilize his/her duties in a technical and professional capacity. I also understand and agree to attend and participate in at least one of the one-on-one classroom/laboratory sessions as a mentor.
Student Signature Date. Faculty Signature Date:
Student Signature Date. Faculty Signature Date: * If needed, the student and faculty member, in consultation with the office of Services for Students with Disabilities (SSWD), will create and attach an accommodation plan to this Student Learning Agreement. Mechanical Engineering Department STUDENT INTERNSHIP REGISTRATION FORM Note: You must already have a job that qualifies. See "Field Work Guidelines” for more information. SAC STATE ID # Last Name First Name Address Street City State Zip Phone (cell) Email Address: **** Please list the best phone and email to reach you (print clearly). **** I have received an offer to work as a student intern at in the position of In this position, my responsibilities will be to I will be working hours/week for weeks for a total of hours. I will register for unit(s) of ME 195 for semester/yr OR unit(s) of ME 295 for semester/yr. (International Students Only): This work experience will be a valuable part of my education since I will be able to apply the knowledge I have gained in the classroom to the real world. This opportunity is not available in my home country of . Student signature Date Work Supervisor Information/Verification: Name Phone Title Company Address “I certify that the student’s work description is correct, and I agree to evaluate the student at the end of the work period.” Work Supervisor’s Signature: ************************************************************************************************************************************************************ ME Dept. Chair/Grad Coordinator signature: Date Office Use: Registered units for (sem/yr) by (initials) (date)
