CAS Internship Office, Cynthia Simon, Director118 Decary Hall, 11 Hills Beach Road, Biddeford, ME 04005

Phone 207-602-2540 Fax 207-602-5880 csimon@une.edu

INTERNSHIP APPROVAL PACKET, 2016The Internship Approval packet is an agreement between the Student, UNE and the Host Site. This Packet:

Describes the internship position to be performed by the Student at the Host Site. Details the academic curriculum to be performed by the Student, including learning outcomes, skill

development, and personal and professional growth. Documents the training, oversight, and schedule the Host Site will provide the Student. Defines the roles of the University and the credentials to be awarded to the Student upon completion.

How to Obtain Internship Approval (check off as complete): Attend one of the mandatory Internship Orientation sessions in 118 Decary Hall.

At least 3 weeks prior to the start of your internship AND before the start of the semester, complete this Approval Packet. This will require you to have three things arranged: a) a set internship schedule agreed upon between you and your supervisor for the duration of the internship semester, b) a basic understanding of your position duties and responsibilities, and c) an ability to fulfill the course requirements as outlined in this packet.

Complete each enclosed form #1, #2, #3, and #5 by typing directly into this packet using Word doc. Do not yet print or sign anything. Send the packet back to me for review at csimon@une.edu; I will review and edit the packet and send it back to you for finalizing. Next….

Make any needed edits per my suggestions, print and sign Approval Forms #1, #2, #3, #4, and #5. (Please do not staple them).

Give your supervisor Approval forms #1, #2, #3, and #4 (not Form #5, Student Waiver), and request they sign them. Your supervisor should keep Form #4, the Supervisor Letter.

Complete, sign and have a witness (such as a family member or friend) sign Form #5.

Submit the entire completed Approval packet (Forms #1, #2, #3, and #5) signed by you and your supervisor as well as a witness, not stapled, to me. Feel free to submit the packet via fax, scan and email, postal mail, or slide under my office door.

Register for the internship course: INTS 200 if you are a 1st or 2nd year student, or INTS 400 if you are a third or fourth year student. Once approved, your course will be changed from the INTS designation to the departmental internship course designation {i.e. BIO 495}. If your internship is offered for a variable number of credits, you may change your credits via U-Online or via petition. Each 1 credit requires 40 contact hours at your internship site.

Successive Interns: purchase the Internship Portfolio from the bookstore (ask for it at the front desk).

College approval takes two to three weeks.

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CAS Internship Office, Cynthia Simon, Director 118 Decary Hall, 11 Hills Beach Road, Biddeford, ME 04005Phone 207-602-2540 Fax 207-602-5880 csimon@une.edu

FORM #1 - INTERNSHIP PROPOSAL

NAME_________________________________________________

MAJOR: ______________________ DUAL MAJOR: ______________ MINOR: ____________

ADVISOR’S NAME ____________________________

UNDERLINE ONE: SR JR SO FR GRADUATION YEAR: _________INTERNSHIP SEMESTER (underline one): Spring Summer Fall Year __2016___NUMBER OF CREDITS: _______ (must match the number of credits for which you are registered on U-Online)

INTERNSHIP COURSE (check one): ____ INTS 200 or ____ INTS 400. AND underline one:ART 401 BIO 295 BUMG 495A EDU 465 ENG 491 ENV 295 MAR 295 HIS 280 LIL 495CMM 495 BIO 495 BUMG 495B MAT 370 ENG 492 ENV 495 MAR 495 HIS 420

STREET ADDRESS WHILE INTERNING________________________________________________________CITY ______________________________________ STATE __________ ZIP CODE ___________________CELL OR LOCAL PHONE # (_________) __________ - ________________ UNE BOX # ____________E-MAIL ______________________________________________________

PERMANENT STREET ADDRESS______________________________________________________________CITY ______________________________________ STATE ___________ ZIP CODE ___________________PERMANENT PHONE # (_______) __________- _______________________

INTERNSHIP SITE NAME______________________________________________________________SITE DESCRIPTION____________________________________________________________________YOUR INTERNSHIP POSITION TITLE__________________________________________________________STREET ADDRESS_____________________________________________________________________CITY ______________________________________ STATE ___________ ZIP CODE ______________SITE SUPERVISOR ____ _ TITLE________________________________PHONE and EXT (____)_______________________ E-MAIL_______________________________________SITE IS: ____ FOR PROFIT. ____ NOT-FOR-PROFIT, GOVERNMENT, or HOSPITAL

If the Site is a for-profit company and you are not paid, you agree that you have read and are a Trainee by definition under the U.S. Department of Labor Fair Labor Standards Act Fact Sheet #71.

INTERNSHIP COMPENSATION INCLUDES: ____ SALARY ____ STIPEND ____ ROOM ____BOARD __X___ Practical education ____CERTIFICATIONS ___OTHER__________________

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CAS Internship Office, Cynthia Simon, Director Decary Hall, 11 Hills Beach Road, Biddeford, ME 04005Phone (207) 602 - 2540, Fax (207) 602 – 5880 csimon@une.edu

FORM #2 - Academic Learning Agreement (ALA)The ALA is a learning contract between the Student, the Host Site and the University that allows UNE to grant the student course credit for the learning achieved. This is completed by the Student with input from the Site Supervisor.

I. Heading:

Student Name ______________________________________________________

Name of Organization __________________________________________________________________

Your internship position title _____________________________________________________________

II. Registration Confirmation: This section is required before continuing to the next sections. Fill in all the blanks and refer to a calendar to assure your total number of full weeks is accurate. This section calculates your credit hours.

Start Date: ___/___/____ -- End Date ___/___/____ = Total # of weeks: _______.

Weekly Schedule of days and hours: ___________________________________________________________________

(Example: Mondays 2 pm – 10 pm, and every other Thursdays 8 am – 2 pm) (Example: Fridays 8am-5pm).

___ Total # Weeks x ___ Total Weekly Hours = ___ Total Contact Hours + 6.5 Classroom Hours (spring and fall semesters only) = ____ Grant Total Hours / 40 Hours per Credit = ___ Credits Available.

Credits Registered =__________ (minimum 3 credits).

III. Academic Learning and Application: Typing directly inside the box below (text boxes expand as you type), open with your title and summarize what it means in a sentence or two. Next, write your job description by listing at least three of your duties and responsibilities, how you will accomplish each (shadow, assist, ask questions, read, write, research, teach, hands-on practice), and especially, what each of them will teach you. Use bullets if you prefer. Examples:

* As a Shadow, I will observe a surgeon at Organization Y, a state of the art medical facility specializing in knee replacements. Through observation I will learn sterilization procedures, patient relations, medical terminology, safety protocols, and medical techniques. I will also assist the front desk with phone calls, patient data entry, and filing. From these tasks I will learn how a medical office is managed for smooth and efficient patient flow and care.

* * As a Conservation Intern, I will be responsible for teaching children about the local habitat, stewardship, and how to affect change for Z Land Trust, an education and conservation group that owns 700 acres in Biddeford. I will write lesson plans and use them to teach environmental education to youth. In so doing I will practice teaching skills and reflect on what methods work best for diverse ages and abilities. I will learn to provide a safe and enjoyable space for the youth. I will accomplish this by shadowing seasoned staff to learn the protocols and practices of the facility. Last, I will apply water chemistry theories to determine the point sources of marine pollution and thus become proficient in learning laboratory water testing techniques. I will learn through training and hands on practice, both in the lab and in the field.

* I will assist a lawyer with case studies, where I will be responsible for researching court precedents and learn how to critically analyze legal cases. Each day the lawyer will review and critique my work. I will also attend court where I will learn case proceedings.

As a ________ for ____________, I will

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IV. Skill Development:

In the below text box, explain those duties and responsibilities that will enable you to practice and enhance your personal, interpersonal and professional skills. State each skill objective and the methods of learning each. Potential soft skills may include decision-making, teamwork, management styles, independence, public speaking, oral communications, and creative writing. Hard skills may include specific technical abilities, new software, and tools and equipment used in this occupation. Include all skills you anticipate gaining. Examples: * While shadowing a physician, I will listen to and practice my oral and written communication skills. I will do this by learning medical terminology and professional oral conduct, and practice it as much as possible. When appropriate, I will also ask questions as they arise in order to further my medical learning.

* As an educator I will need to problem-solve. Opportunities to practice this skill will arise during active teaching as well as down times as I attempt to teach and oversee youth with diverse abilities and from diverse cultures. My supervisor will provide consistent verbal feedback on my problem solving.

For each duty below I expect to gain the following skills, learned in the way described in each bullet below:

*

*

*

*

V. Personal Development: Here, explain why you are taking the internship course and why you chose your particular site and/or position. State the objectives you hope to develop, and the method (tasks and strategies) you will employ for each objective. Examples: Self-confidence, sensitivity to others, appreciation for diversity, clarification of values, life goals, improved ability to learn in a self-directed manner, develop and apply moral judgment, develop a work ethic, incorporate cultural differences into a world view, mature professionally, foster collaboration, practice professional conduct, secure relevant experience toward graduate school, decide upon career options, learn about a particular job, gain professional networks.

VI. Evaluation: I AGREE I WILL BE EVALUATED USING THE FOLLOWING CRITERIA. I agree to follow the current course syllabus which will provide instructions and due dates for each assignment.

ALL INTERNS 300-LEVEL, 400-LEVEL AND SUCCESSIVE INTERNS

Completion of Contact hours ADDITIONAL ASSIGNMENTS

Weekly Journal Entries Cover Letter

Photo at Internship Resume

Summary Paragraph of Internship Statement of Professional Goals

Thank you Letter to Supervisor Statement of Work Ethic

Student Evaluation Professional Portfolio

Attendance at Two Internship Workshops

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VII. SIGNATURES for FORM #2 (ALA):

STUDENT INTERN: I concur with and accept the academic and internship site assignments indicated in the Academic Learning Agreement. I agree to complete all internship assignments promptly and to the best of my ability. I accept the obligation of confidentiality in my work and relationship with the site supervisor. I agree to familiarize myself with and adhere to the relevant organization policies, procedures and functions and to the appropriate standards of ethical conduct.

_____________________________________________________________________ _________________

Signature of Student Intern Date

INTERNSHIP SITE SUPERVISOR: I have discussed this internship with the student and have negotiated and assigned the internship components which appear on the Academic Learning Agreement. I concur with the stipulations of the Academic Learning Agreement, as of the date of my signature. I further agree to provide the Student Intern with an orientation concerning relevant organizational policies, procedures and functions, to meet with the intern regularly, and to be available for counsel and advice for the duration of the internship. I agree to keep a log of student hours completed and to conduct and submit to the Internship Office a written evaluation of the student near to the completion of the internship.

_____________________________________________________________________ _________________

Signature of Site Supervisor Date

_______________________________________________________ __________________________________

E-Mail Address Phone

University Administration Only:

UNE ADMINISTRATION SIGNATURES: I approve this Academic Agreement as the basis of a credit-bearing internship course.

Internship Director______________________________________________________________________ Date _____________

Department Chair ______________________________________________________________________ Date _____________

Associate Dean _________________________________________________________________________ Date _____________

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CAS Internship Office, Cynthia Simon, DirectorDecary Hall, 11 Hills Beach Road, Biddeford, ME 04005

(207) 602 - 2540, fax (207) 602 – 5880 csimon@une.edu

FORM #3 - University – Agency Internship Site AgreementThis Site Agreement is made on this date, ____/____/____, between me as the Student, _____________________, the University of New England, and the Agency, _________________________________________________.

Students assigned to an Internship will be determined by the representatives of the University and Agency, who will cooperate in developing methods of instruction, objectives and other details of the Internship to satisfy University curriculum and Agency requirements.

The University of New England’s CAS Internship Office is responsible for preparing students for the academic internship experience. Students are required to follow all of the rules, regulations, and procedures of the Agency. If any problems arise during the Internship, the University’s CAS Internship Director will be notified and will work with the representatives from the Agency to mutually resolve such issues. If the issues cannot be resolved, the Student Internship may be terminated. If the University cancels classes due to inclement weather on a day the student is scheduled to perform internship hours, the student will not be required to perform hours on that day, but will notify the Agency of the cancellation and arrange for make-up hours at the Agency’s discretion.

The Agency will provide the student with a thorough orientation and training. An Agency staff Site Supervisor will evaluate the student’s performance by written evaluation and mutual consultation.

The Agency will retain full responsibility for the clients of the Agency and will maintain administrative and professional supervision of students insofar as their presence affects the operation of the Agency and/or the direct or indirect provision of services of the clients of the Agency.

The Agency read and understands the Department of Labor’s Fair Labor Standards Act Fact Sheet #71 regarding Intern compensation regulations: http://www.dol.gov/whd/regs/compliance/whdfs71.htm

The Agency will be responsible for arranging immediate transport and care in case of accident or illness to the student, but it is not responsible for the costs involved, follow-up care or hospitalization.

The University and the Agency do not and will not discriminate against any application for the Internship because of race, color, religion, gender, sexual orientation, or age. This agreement will go into effect on the day that signatures of the University and Agency are affixed below.

Student Intern ___________________________________________________________ Date: __________

Internship Site Supervisor __________________________________________________ Date: __________

UNE, CAS Internship Director ________________________________________________ Date: __________

UNE, CAS Associate Dean ___________________________________________________ Date: __________

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Cynthia Simon, Director, Internship OfficeDecary Hall, 11 Hills Beach Road, Biddeford, ME 04005

Ph: (207) 602-2540 Fax: (207) 602–5880 Email: csimon@une.edu Web: www.une.edu/cas/internships

FORM #4 – Supervisor LetterDear Supervisor,

Thank you for supporting our student with an academic (credit-bearing) internship. Interns are highly motivated to learn, and should strive to glean the most from this opportunity as a significant contribution to their academic and professional pursuits. The Intern will hope to quickly become familiar with your expectations, the layout of the organization, and the communication style of the staff.

The Intern has researched and specifically chosen your organization, and is committed to your organization’s efforts. She/he desires to learn and gain experience and is looking to you for that opportunity. You can anticipate that the Intern will perform their assigned tasks to the best of their ability and will take great pride in working with you. Throughout days of successes and the occasional trial, each day will be a learning curve. Each of us benefits greatly from this internship - the student gains new knowledge, skills, and experience; your organization receives fresh insight, talent, support, and a potential future employee familiar with your organization and trained in a capacity; and the University gleans greater community outreach and dialogue, and better prepared graduates ready for successful careers.

Whether shadow, volunteer or paid, our students receive academic credit for approved internships. To that end, the Intern is submitting paperwork to you in order to receive credit for their internship. We ask that this Approval Packet be completed before the student begins their internship hours. The forms should already be signed by the student. Please sign the forms and return them to the student, or directly to me at the above address. The following require your signature before the Internship should begin:

Site Agreement (the signature form that acknowledges the responsibilities of each party) Academic Learning Agreement (the form the student completes that defines their internship position, duties and

responsibilities, and the in-turn training, skill and knowledge to be gained from your organization)

As the Host Site and Supervisor, your roles are to:1. Agree to and sign the Internship Approval Forms, as described above, before the internship begins2. Provide the student with adequate orientation, training and supervision for their internship position3. Support the student in fulfilling her or his learning objectives, schedule, and goals, per the Academic Agreement4. Allow the student to complete their required hours, and keep an accurate log of the student’s internship hours 5. Complete a Supervisor Evaluation Form, to be provided to you by the student near to the end of the Internship

The Student’s responsibilities are to: 1. Be approved and registered for the internship course.2. Attend classes, workshops or meetings as required with the Internship Director.3. Responsibly perform and successfully complete all the hours they committed to the internship with your organization.4. Complete academic assignments as assigned by the Internship Director.5. Receive an acceptable Site Supervisor’s Evaluation of their performance with your organization.

Thank you for supporting the student and the UNE CAS Internship Program. I will contact you shortly, and please contact me any time with questions or comments. I hope our mutual experience is beneficial and extraordinary!

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FORM #5 - UNIVERSITY OF NEW ENGLANDSTUDENT AGREEMENT AND WAIVER OF LIABILITY FOR INTERNSHIPS, COMMUNITY INVOLVEMENT

AND OTHER EXPERIENTIAL EDUCATIONAL LEARNING ACTIVITIES

The University of New England (“UNE” or “University”) offers opportunities for undergraduate students to take their learning outside the classroom through internships, volunteering, and other forms of experiential learning. UNE seeks to prepare competent, professional, and prepared students to engage respectfully with schools, businesses, and government/community agencies and further seeks to ensure the health and safety of all UNE students and employees engaged in University sponsored internships, community involvement, and other experiential educational learning activities. However, no one can guarantee another’s absolute safety.

To this end, prior to your participation, it is necessary for you to read, understand and sign this “Student Agreement and Waiver of Liability For Internships, Community Involvement and Other Experiential Educational Learning Activities” (“Release Form”). As stated below, this Release Form releases the University, its agents, employees, officers, directors and/or trustees from any and all liability for any harm and/or injury you may suffer while participating in an out of the classroom course activity. If you are below the age of eighteen (18), this Release Form must also be reviewed, understood, and signed by your parent/legal guardian. If you choose not to sign this Release Form, or, if applicable, your parent/legal guardian chooses not to sign this Release Form, you may not be allowed to participate.

Once you and if applicable your parent/legal guardian have read, understand, and sign this Release Form, please return it to:

University of New EnglandCynthia Simon, Internship DirectorCAS Internship Office, 118 Decary Hall11 Hills Beach Road, Biddeford, ME 04005

Name: ______________________________________ Student ID #: _______________________________

Date of Birth: __________________ YOUR CURRENT GPA ___________ (this is used only to alert you to scholarships and other qualifying opportunities)

(If applicant is under 18 years of age, a parent or legal guardian must also read and sign this form.)

Course: INTS _____ / _________. Internship/Community Activity: ________________________________ (Name of host site and your position title)

Have you ever been convicted of a felony? ____ Yes ____ No If yes, please explain:________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

Have you ever been terminated from a volunteer, internship, or work experience for behavioral reasons? ____ Yes ____ No If yes, please explain:

________________________________________________________________________________________________________________________________________________________________

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Is there any reason that you are not prepared or able to work in the community at an internship site? ____ Yes ____ No If yes, please explain:________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

Designated Contact Person/Medical Information:

Please list any allergies, medicines, or medical alert information:________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

Person to contact in case of emergency:

Name_________________________________________________________________________Relationship to Applicant _________________________________________________Street Address__________________________________________________________________City ___________________________________ State ________ Zip Code ____________Phone Numbers: Home: (____) ______________________ Work: (____) _____________________Cell: (____) _____________________________

RELEASE OF LIABILITY AND ASSUMPTION OF RISKS

THIS RELEASE OF LIABILITY AND ASSUMPTION OR RISKS (the “Release”) is executed by _________________________ (your first and last name) whose address is _______________________________________ (city and state) ( the “Releasor”) in favor of University of New England, a private, non-profit Maine corporation with a place of business at 11 Hills Beach Road, City of Biddeford, County of York, State of Maine (the “University”).

1. PARTICIPATION IN INTERNSHIPS AND COMMUNITY ACTIVITES. As a student of University, I desire to participate in off campus internships, community activities or other experiential educational activities. I acknowledge that I have VOLUNTEERED to participate and acknowledge that the University offers multiple courses and off and on-campus programs through which I may receive requisite credits, including any required internship credits.

2. RELEASE AND WAIVER OF UNIVERSITY LIABILITY FOR DANGERS AND RISKS AND INDEMNIFICATION. I understand that there are certain dangers, hazards, and risks to which I may be exposed by my participation in the internship, community and other experiential educational activity which can cause or result in damage or destruction to my personal property and personal injury to myself, including my death. I further understand that the University cannot and does not assume responsibility for any such personal injury, death or property damage.

I hereby expressly release and forever discharge University, its trustees, officers, directors, employees, agents, members, sponsors, promoters and affiliates from any and all liability, claim, loss, cost or expense, and waive all rights and claims and promise not to sue on any such claims against any such person or organization, arising directly or indirectly from or attributable in any legal way to any negligence, action or omission to act of any such person or organization in connection with the sponsorship, organization or execution of the internship or

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community involvement in which I may participate in any capacity or arising out of my participation in or association with these activities, or travel to and from the location of the internship or community activity.

Should I or my heirs, executors, successors or assigns assert any claim in contravention of this agreement, I or my heirs, executors, successors or assigns shall be liable for the expenses (including legal fees and costs) incurred by the party or parties in defending the claim(s) and I hereby expressly agree to fully indemnify and hold University harmless from all such expenses, damages, and costs expressly including attorneys’ fees and costs.

3. ASSUMPTION OF RISKS. Notwithstanding the dangers, hazards, and risks involved, and in consideration of being permitted to participate in the internship, community activity or other experiential educational activity:

(i) I agree and hereby do assume all risks surrounding my participation and in the activities I undertake in connection therewith; and

(ii) I agree and hereby do release and forever discharge the University, its trustees, directors, officers, agents, affiliates, sponsors, members, promoters, employees, and any students acting as employees (hereafter collectively called the “Releasees”), from any and all liability for any injury, damage, claim, demand, action, cost, and expense of any nature, both in law and in equity, that I may at any time have or incur, arising out of or in any manner related to any loss, damage, injury, including but not limited to emotional pain, suffering and death, that may be sustained by me or by any property belonging to me during my participation.

4. DISCLAIMER OF UNIVERSITY RESPONSIBILITY. I understand and agree that the University is:

(i) not responsible or liable for any injury, damage, loss, accident or delay which may be caused by a defect in any vehicle or other mode of transportation, or the negligence or other wrongful act of any party engaged to provide services connected with my travel. I understand that it is my responsibility to arrange for my travel and that if I am driving myself I am required by law to be covered by automobile liability insurance coverage.

(ii) not responsible or liable for any injury, damage, loss or expense due to sickness, weather, strikes, hostilities, wars, natural disasters, terrorism, or other such causes,

(iii) not responsible or liable for disruption of travel arrangements, or any consequent additional expenses that may be incurred there from, and

(iv) not responsible or liable for any loss, damage, or theft of my personal belongings.

5. RESPONSIBILITY FOR MEDICAL NEEDS.

I represent, covenant and warrant to the University that I have consulted with a medical doctor with regard to my medical needs; that I am aware of my personal medical needs and that there are no health-related reasons or problems which preclude or restrict my participation. I acknowledge that the University has required that I obtain insurance coverage to protect against the cost of hospitalization and physician care in the event of sickness, accident, injury and/or disability. I understand that I am solely responsible for obtaining and paying the cost of such insurance and that I am required to have a copy of such insurance on my person while traveling and while participating in the internship or community activity. I further understand and agree that (i) the University is not responsible for attending to any of my medical or medication needs, (ii) I assume all risks and responsibility for my medical and medication needs, and (iii) if I am required to be hospitalized any time during my participation, the University does not assume any legal responsibility for payment of such costs.

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6. EMERGENCY MEDICAL TREATMENT. I understand that the Releasees do not have medical personnel available to me at any time during my participation. I acknowledge that the University has required that I designate a contact person in the event of an emergency and that I am required to carry on my person while traveling to/from and while participating in activities at the location of the internship, community or other experiential educational activity a Medical Emergency Card that (1) identifies the name and telephone number of my designated contact person and (2) personal medical information. In the event of a medical emergency, I grant to my designated contact person permission to authorize emergency medical treatment, including surgery and I agree that if such action is by a designated contact person who is a Releasee that it shall be subject to the terms of this Release. I further understand and agree that Releasees assume no liability or responsibility for any injury or damage which might arise out of or in connection with such authorized emergency medical treatment or the costs of such emergency medical treatment. I further understand and agree that Releasees are not responsible for, and assume no liability or responsibility to contact my designated contact person or any failed efforts by a hospital, physician or other health care provider to contact my designated contact person. In the absence of authorization by my designated contact person due to a failure to reach my designated contact person, I understand and assume the risk that decisions regarding emergency medical treatment may be made by a hospital, physician or other health care provider and that Releasees assume no liability or responsibility for such decisions.

7. LEGAL PROBLEMS. I understand that if I have a legal problem during my participation in the internship, community or other experiential educational activity, I will be solely responsible for attending to the matter personally with my own funds and that the University is not responsible for providing any assistance legal or otherwise to me under such circumstances.

8. BINDING NATURE OF RELEASE. It is my express intent that this Release shall bind the members of my family (including my spouse, dependents and children, if any) if I am alive, and my heirs, personal representatives, successors, and assigns if I am deceased.

9. INDEMNIFICATION. I agree to indemnify, defend and hold the Releasees harmless from any liability, claim, action, debt, damage, loss, cost and expense of every kind or nature, including attorney’s fees, asserted by any party against any Releasees or incurred by any Releasee and arising directly or indirectly from or in connection with my participation in any of the activities I engage in during the internship, community activity and my travel to and from such activities.

10. RESERVATION OF RIGHTS. I acknowledge that the University reserves the following rights that it may exercise in its sole discretion: (i) the right to cancel the internship, community or other experiential educational activity, in its sole discretion and (ii) the right to make alterations, changes, and modifications in the format and administration of the internship, community or other experiential educational activity.

11. STANDARDS OF CONDUCT. By signing below, I agree to abide by all policies and procedures outlined by the University and all policies and procedures of the internship or community site. I understand that the University has no control over the operations or premises of the internship or community site and that I will be under the supervision of a representative of the internship or community organization. I understand and acknowledge that my failure to comply with said polices during my internship, community or other experiential educational activity or my exhibition of any behavior detrimental to or incompatible with the interest, harmony, and welfare of the University, the internship organization, community or other experiential educational activity or other student participants may result in disciplinary action against me including but not limited to a non-voluntary withdrawal from the course and/or internship, community or other experiential educational activity.

12. COMPLIANCE WITH LAWS. I agree to comply with all state and federal laws, rules and regulations as applicable.

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13. DISCLOSURE. THE UNIVERSITY HAS INFORMED ME THAT BY SIGNING THIS DOCUMENT I RELEASE AND WAIVE CERTAIN LEGAL RIGHTS THAT I OTHERWISE MIGHT HAVE, AND THAT I HAVE THE RIGHT AND OPPORTUNITY TO SEEK INDEPENDENT LEGAL ADVICE BEFORE SIGNING THIS DOCUMENT AND THAT I SHOULD READ THE DOCUMENT CAREFULLY AND UNDERSTAND IT FULLY BEFORE SIGNING.

14. REPRESENTATIONS. I represent to the University that (i) I understand my right and opportunity to seek independent legal advice; (ii) I have read this Release, including Exhibit “A” attached hereto and fully understand the contents and the effect of its terms and provisions, (iii) I sign the Release as my own free act and deed, (iv) with respect to the matters set forth in this Release, no oral representations, statements or inducements other than those expressly contained herein have been made to me by any of the Releasees, (vi) I execute this release for complete and adequate consideration, fully intending to be bound by the same.

15. GOVERNING LAW. I agree that this Release shall be constructed in accordance with the laws of the State of Maine.

16. PARTIAL INVALIDITY. If any term or provision of this Release shall be held illegal, unenforceable, or in conflict with any law governing this Release, then I agree that the validity of all remaining terms and provisions shall not be affected thereby.

IN WITNESS WHEREOF, I/WE have executed this Release of Liability and Assumptions of Risks this _________ day of _________________ 20___ ___.

STUDENT RELEASOR: WITNESS: must be over 18 and not your supervisor

Signature Signature

Printed Name Printed Name

Parent/Legal Guardian: If the Student is a minor, I verify that I am the parent or guardian of the minor and have the authority to sign this Release Form and I agree to be bound by its terms and conditions. I further understand that as the parent/guardian I agree to indemnify and hold harmless the Releasees as set forth in this Release Form.

WITNESS PARENT/LEGAL GUARDIAN

Signature Signature

Printed Name Printed Name

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EXHIBIT “A”

The following are examples only of problems and/or hazards that participants may experience:

1) Catastrophic travel via local automobile or otherwise;

2) Natural catastrophic events, e.g. snow, sleet, ice storms, flooding, power outages, etc.

3) Theft;

4) Sexual harassment and unwelcome sexual comments or advances;

5) Illegal drug availability in the community;

6) And any other foreseen or unforeseen circumstances that can cause problems, permanent damage or even death.

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