EXPERIENTIAL
LEARNING AGREEMENT
Semester
participating:
Document Due Date:
Spring
December 1
Summer
April 1
Fall
July 1
-
Completed
Experiential Learning Agreement with signatures
(Keep a copy for your records)
-
Learning
Objectives (3 required; Refer to worksheet on “Guidelines to Writing
Objectives”)
-
Resume
-
Copy
of your Academic History from DUCK
-
Copy
of your CIT and AASIT graduation applications
Student
csu _________@mail.claytonstate.net
IT
Emphasis ____________________________________
Current Overall GPA ____________
Course
# ITFN 2012 - 2 credits
ITFN 4014 - circle one:
3 credits or 6 credits
Host
Organization (Intern Site) _____________________________________________________
Host
Address __________________________________________________________________
______________________________________________
County _________________________
Site
Supervisor _________________________________
Title ___________________________
(May not be a relative or a current student)
Supervisor’s
Phone _____________________________
E-mail ________________________
Technical
Supervisor ____________________________________________________________
(May
be same as Site Supervisor)
Supervisor’s
Phone _____________________________
E-mail ________________________
This
Experiential Learning Agreement
is established to provide a basis of understanding between Clayton State University (Clayton State University), the experiential learning student, and the
host organization. This
agreement commits neither the host organization nor the student to
permanent employment.
The
Clayton State University Director of Experiential
Learning and Faculty Coordinator agree to:
1.
Screen experiential learning applicants to identify potential
candidates.
2.
Provide related academic assignments coordinated with the field
learning experience.
3.
Communicate with site and technical supervisor(s) throughout the
semester to evaluate student’s work performance.
4.
Assess degree to which student meets stated learning objectives.
The
Student agrees to:
1.
Attend required orientation meeting; worth 5% toward class grade;
see semester schedule/syllabus.
2.
Follow the rules and policies that apply to all employees.
3.
Perform assigned tasks in a responsible manner.
4.
Demonstrate honesty, punctuality, cooperation, courtesy, and a
willingness to learn.
5.
Maintain regular attendance at both Clayton State University and the learning site.
6.
Avoid unsafe acts and be alert to unsafe conditions.
7.
Notify appropriate host organization personnel or Clayton State University Director of
Experiential Learning of any significant difficulties experienced at the
learning site.
8.
Provide records or reports required by either Clayton State University or the host
organization.
9.
Facilitate obtaining and reviewing the final evaluation from
supervisor(s).
The
Host Organization agrees to:
1.
Provide a field learning experience that permits the student to
meet her/his learning objectives.
2.
Provide supervision that emphasizes the student’s safety as well
as the learning objectives.
3.
Clarify to permanent employees the expectations of the student’s
learning experience.
4.
Notify Clayton State University in a timely manner of any serious problems related to
the field learning experience, including a need to terminate student’s
placement.
5.
Furnish all necessary supplies and equipment.
6.
Communicate periodically with Clayton State University representatives regarding
student’s work performance.
7.
Complete a final evaluation on a designated form at the end of each
semester and review the evaluation with the student. (This evaluation will
provide input for the student’s course grade.)
We,
the undersigned, agree to the conditions set forth in this Experiential
Learning Agreement (see reverse).
PRINT
NAME
SIGNATURE
DATE
Student
Site
Supervisor
Technical
Supervisor
(may
be the same as Site Supervisor)
DO
NOT WRITE BELOW THIS LINE
Faculty
Coordinator Signature _________________________
Date ________
APPROVED
DENIED
Rev. 06/03
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