Academic Internship New/Update Opportunity

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Academic Internship Opportinuties

Thank you for your interest in offering for-credit internship opportunities at California State Univeristy San Marcos.

This form allows you to submit additional and/or update academic internship opportunities offered by your organization.

Ideally, a representative of the organization who is familiar with the learning activities that university students will be engaged in, as well as your safety policies and procedures should complete this form.

Note: CSU faculty or students cannot complete this form on behalf of an organization.

Legal Name of Organization *

Site Address *

Please provide the address where students will engage in this opportunity.

Address 1 *

Address 2

City *

State *

ZIP code *

Supervisor Information

Please provide details of the individual who will be supervising the student(s) during their internship.

Supervisor First Name *

Supervisor Last Name *

Supervisor Position Title *

Supervisor Phone *

Supervisor Phone, part 1

Supervisor Phone, part 2

Supervisor Phone, part 3

ext.

Supervisor Phone, part 4

Supervisor Email *

Opportunity Information

Please provide information about the specific opportunity you have available for students enrolled at our institution.

Has a student been selected for this opportunity? *

Student's Name(s) *

Student's Email(s)

Opportunity Title *

Opportunity Summary *

Describe the knowledge or skills students may acquire by the end of the opportunity: *

Tip: Provide a detailed and comprehensive description to attract more applicants.

Please select the tasks/activities students would be doing for this opportunity (select all that apply)

Start typing common words to search the list for related activities.

What training will be provided to students to perform these responsibilities? *

How will you provide ongoing support and supervision to students? *

Where can these responsibilities be performed? *

Would the opportunity include or require a written agreement between CSUSM and the organization giving CSUSM use or control of space at the opportunity location(s)? (i.e. an agreement for use of space) *

Yes

Please provide any safety information specific to this opportunity.

Please indicate the number of hours and duration a student would need to commit for this opportunity.
*THIS FIELD IS REQUIRED*

NOTE: An Academic Term is 16 weeks.
Hours*	Duration*
Hours *	Duration *

When is this opportunity available? *

Please select the term(s) that this opportunity is available.

A "term" corresponds with a semester on our campus Academic Calendar.

Are students expected to use a personal vehicle to participate in this opportunity? *

Example: They will need to use a personal vehicle to deliver supplies to a site.

Are students responsible for any fees as part of this opportunity? *

Are students receiving any form of compensation for this opportunity? *

Will the student be a W2 employee earning at least minimum wage? *

Refer to US Department of Labor: https://www.dol.gov/agencies/whd/minimum-wage/state

Yes

Please provide compensation details
*THIS FIELD IS REQUIRED*

NOTE: For all forms of reimbursement, please provide more detailed information in the explanation box.
Type*	Frequency*	Amount*	Explain Other	Show this to students?*
Type *	Frequency *	Amount *	Explain Other	Show this to students? *

I verify we comply with Cal/OSHA standards (if outside CA, complies with federal and state employment laws) *

Yes

Please provide application instructions for students *

Please list step-by-step instructions for the student to apply.

Site Safety Questions

This risk assessment is not intended to prohibit educational experiences that may seem “too risky,” but rather to find ways to reduce the amount of risk and liability exposure, so that the off-campus learning opportunity is a safe, healthful and fulfilling educational experience for all parties involved. This section should be completed by someone familiar with any potential risks.

Please select all options that apply. *

You will be asked to provide additional information as needed based on your responses.

KNOWN HAZARDS: This placement requires working with heavy equipment, construction equipment, heights, or heavy machinery.

KNOWN HAZARDS: Students will be working with chemical and/or biological hazardous materials or in a lab environment/ with lab equipment.

POPULATION SERVED: Students may be working with minors, elderly, behaviorally challenged populations or individuals who have a known criminal background or history of violent behavior.

SITE LOCATION: Parking and work areas may not be secure or adequately illuminated, or may present other location-related hazards.

SITE LOCATION: There have been incidents of criminal activity at the organization or site(s) within the last year. Or, the location would be described as a high-crime area.

SUPERVISION: Students may be required to work alone at night (6pm - 8am). And/or, students may be supervised less than 50% of the time.

None of the above options apply to this organization

None of the above options apply to this organization.

KNOWN HAZARDS: Please clarify your selection(s). *

Briefly provide further information on the following as related to machinery/equipment/height risks (if applicable):

1. Please describe machinery/equipment/heights that may be used by intern

2. Safety training students will receive

3. Safety standards and protocols related to use of stated equipment (eg. OSHA standards, any organizational policies above and beyond OSHA requirements, etc.)

4. Required protective equipment (if any)

5. Any other procedures in place to mitigate risk of injury

KNOWN HAZARDS: Please clarify your selection(s). *

Briefly provide further information on the following as related to chemical and/or biological hazards (if applicable) *NOTE: You do not need to list each individual chemical*:

1. Training students will receive to safely handle lab equipment, chemical and/or biologically derived materials

2. Safety standards and protocols related to the handling of chemical and biological materials (eg. OSHA standards, any organizational policies above and beyond OSHA requirements, etc.)

3. Required protective equipment (if any)

4. Any other procedures in place to mitigate risk of injury

POPULATION SERVED: Please clarify your selection(s). *

Please expand on the special or vulnerable populations the student will or may be working with and include information on whether the student will always be partnered with another staff, supervisor, or other trained professional when working with any of these special populations. If supervision is limited, please expand on additional safety protocols.

SITE LOCATION: Please clarify your selection(s). *

Briefly provide further information as related to the physical safety of the location (if applicable):

1. Details concerning security at the site where interns will be working.

2. History of criminal activity in the area that you are aware of?

3. Details of parking facility security (is it secured and/or patrolled)?

4. Any additional safety information?

SUPERVISION: Please clarify your selection(s). *

1. Will the intern be working alone at night (between 6pm and 8am)?

2. Approximately how much of the time (in a percentage) will the student be working without direct supervision?

3. Please provide details on how the interns work will be directed when a supervision is not in place?

Is there anything else not covered that might impact the health or safety of the student intern?

Risk Confirmation *

I have filled out the risk and safety information of this organization to the best of my knowledge.

Acknowledgement

Site Orientation Requirement *

I understand my organization is required to provide the intern with a safety training/orientation pertaining to potential risks associated with the nature of the industry and organization prior to the start of the internship or service learning hours.

As a representative of this company, I acknowledge and agree to the information provided in the CSUSM Community Partner Academic Internship Handbook. *

Clear signature

Administer, conduct, or oversee an assessment process
Analyze and/or study data
Assist a professional
Assist with accounting/legal paperwork or tax preparation
Conduct mapping and/or surveying
Conduct scientific analysis and/or testing
Create curriculum, lesson plans, and/or activities (including physical or hands-on activities)
Create evaluations, assessments, or survey instruments
Create or promote marketing content
Create written or digital content (e.g. graphic design, photos, website, blog/article, social media posts)
Deliver and/or package goods
Develop or perform a play, immersive story, short film/video, or concert
Develop technical content or materials (e.g. policy development, grant writing, tutorials, software/web development)
Develop, present and/or facilitate a workshop, training, or tour
Edit digital content (e.g. images, videos, web content)
Engage in a research and/or scholarly activity
Engage in play or fitness activities with clients
Gather and/or write oral histories
Install pre-fabricated materials or equipment (including assisting)
Observe a professional and/or client
Participate in a painting, building, renovation or construction activity (such as, neighborhood/housing restoration or building theater props or playgrounds, etc)
Participate in a workshop, training, or orientation
Participate in an environmental restoration, planting/gardening and/or recycling activity
Participate in and/or lead outreach efforts
Participate in office and/or supervisor meeting
Plan, organize, or lead an event, program, or community project
Prepare and/or serve food
Provide general office administration (e.g. filing, data entry, processing forms, intra-office communication, meeting preparation, returning phone calls)
Provide translation and/or transcription services
Received Direct Supervision
Search and/or investigate potential locations or buildings
Serve as a caregiver/caretaker
Serve as a client advocate/case manager
Serve as a counselor/therapist individually or as part of a group
Serve as a mentor
Serve as a tutor
Serve in a coaching role
Serve in a customer service/concierge role
Serve in a supervision or professional consulting role
Serve in a teaching role (including in an assistant role)
Serve in an advising/counseling role
Shadow a professional
Sort donated goods (such as, food, clothing, electronics, household items)
Support fundraising efforts (e.g. grant writing research, donor/donation outreach, collection drives)
Support or assist with an event, program, or community project
Train clients