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Student Internship Approval Form & Internship Programs Student Liability Release Form

Name*
Have you completed at least 24 credits in the College of Business? *
Is this your first internship? *
Are you an international student? If you select yes, please complete the CPT Packet: http://www.ferris.edu/international/currentstudents/pdfs-docs/CPT_Packet.pdf*
Please note that Ferris State University campus internships DO NOT require a CPT form.

Internship Host-Site (Company) Contact Information

Street Address

Position Information

Your learning objectives should identify four key elements you hope to achieve during your internship. Your learning objectives should be measurable and achievable. Each learning objective should be 1-2 sentences.
Start Date of Internship (estimate if needed)*
End Date of Internship (estimate if needed)*
I understand that I must submit a minimum of 4 approved learning objective statements before I am enrolled in the internship course.*
I agree that a family member (including extended family) MAY NOT be an immediate internship supervisor or performance evaluator at the internship host-site.*
False or inaccurate information provided will result in immediate termination from internship partner opportunities, and is subject to review by the Ferris State University College of Business, and the Ferris State University General Counsel's Office. The information provided is accurate to the best of my knowledge.*
RESPONSIBILITIES OF STUDENT AND ASSUMPTION OF RISK*

Internship Programs Student Liability Release Form

This is a legally binding Liability Release Form executed by me, to Ferris State University, a constitutional body corporate of the State of Michigan, 119 South Street, Big Rapids, Michigan 49307. I am a student who wishes to participate in an internship placement, I have thoroughly investigated the internship site, spoken to the representative of the internship site, voluntarily agree to the internship placement at this site, and understand any dangers that may be associated with the site. I have not relied upon any representation from Ferris State University in selecting this internship placement.*
In consideration of Ferris State University granting permission to participate in the College of Business Internship Program, acting for myself, my heirs, personal representatives and assigns, do hereby release, waive, and forever discharge Ferris State University; and their Board of Trustees, employees, agents and representatives (Releasees) from any and all liability of any and every nature whatsoever, including claims of suits at law or in equity, that I may have, for any and all personal injury, including death, and property loss or damage that may result from my participation in the Internship. I hereby agree to indemnify and hold harmless the Releasees from such liability whether injury is caused in whole or in part by my fault or negligence, the fault or negligence of the Releasees or the fault or negligence of any third party. By signing below I understand the potential dangers associated with this activity. The hazards include, but are not limited to: personal injury, personal medical conditions, vehicular accident, adverse weather conditions, and/or property loss or damage. I do hereby elect to voluntarily participate in this internship and do so at my own risk. I know that if I become injured while participating in the internship experience, I am responsible for my health care expenses and I have made arrangements to handle such expenses through insurance coverage, access to cash, or other methods. I assume full responsibility for any and all claims and costs (including my own), arising directly or indirectly out of activities, acts, or omissions while participating in the Internship Program. I HAVE CAREFULLY READ AND UNDERSTAND COMPLETELY THE ABOVE PROVISIONS AND VOLUNTARILY SIGN THIS LIABILITY RELEASE FORM.*
Date/Time
:  

Internship Office Review

Academic Standing

Faculty Approval for Internship Registration

I have reviewed the student request for internship registration.*
Register for:
Internship Semester/Year
Faculty or Department Representative Name*

Registration Checklist

Registration