CLAYTON COLLEGE & STATE
UNIVERSITY
INFORMATION TECHNOLOGY
EXPERIENTIAL LEARNING AGREEMENT
Four weeks before the start of the semester, submit
the following to your Faculty Coordinator:
- 1) Completed
Experiential Learning Agreement with signatures,
- 2) Resume,
- 3) Copy of your
Academic History from DUCK and
- 4) Copy of your CIT
and AASIT graduation application.
Semester participating:
—
Spring (DUE December
1)
—
Summer (DUE April 1)
—
Fall (DUE July 1)
Student
E-mail
IT
Emphasis
Course # 3 or 6 credit
Host
Organization (Intern Site)
Host
Address
Site
Supervisor
Title
Supervisor’s
Phone
E-mail
Technical
Supervisor (may be
same as Site Supervisor)
Supervisor’s
Phone E-mail
Working with the Site
Supervisor and/or the Technical Supervisor, the student determines the
objectives to be accomplished while participating in Experiential Learning.
1.
Learning
Objective
Duties, responsibilities, and activities for meeting objective
2.
Learning
Objective_________________________________________________________
Duties,
responsibilities, and activities for meeting objective
3.
Learning
Objective_________________________________________________________
Duties,
responsibilities, and activities for meeting objective
(Additional Learning
Objectives may be listed on an attached sheet.)
This
Experiential Learning Agreement is established to provide a basis of
understanding between Clayton College & State University (CCSU), the
experiential learning student, and the host organization. This agreement
commits neither the host organization nor the student to permanent employment.
The
CCSU 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.
Follow the rules and policies that apply to all employees.
2.
Perform assigned tasks in a responsible manner.
3.
Demonstrate honesty, punctuality, cooperation, courtesy, and a
willingness to learn.
4.
Maintain regular attendance both at CCSU and at the learning site
5.
Avoid unsafe acts and be alert to unsafe conditions.
6.
Notify appropriate host organization personnel or CCSU Director of
Experiential Learning of any significant difficulties experienced at the
learning site.
7.
Provide records or reports required by either CCSU or the host
organization.
8.
Facilitate obtaining 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 CCSU 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 CCSU representatives regarding student’s
work performance.
7.
Complete a final evaluation on a designated form at the end of each
semester. 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.
PRINT
NAME SIGNATURE
DATE
Student
Site
Supervisor
Technical
Supervisor
(may
be the same as Site Supervisor)
DO
NOT WRITE BELOW THIS LINE
—
APPROVED
— DENIED
Faculty Coordinator Signature
Date