Internship Intake Application

"*" indicates required fields

Student Details

Name*

Age*

Grade*

School Name*

Address*

Street Address City State ZIP Code

Phone*

Email*

Internship Details

Address*

Street Address City State ZIP Code

Phone*

Website*

Supervisor Name*

Title*

Phone*

Email*

This Internship is designed to introduce the student to various types of career opportunities This Internship is flexible - An agreement of work hours will be agreed upon by the student, parent, and supervisor.

Description of Internship responsibilities:*

What do you hope to gain from internship?*

Requirements:
• 100 hour program under the supervision of a company owner, manager, supervisor
• Internship must be approved by Talia Landry, ARP-AIRE Grant Manager
• Contract with supervisor, grant manager, and intern.
• Three (3) completed Time records with goals and supervisor report
• A typed final 250 word essay detailing goals, details, findings, etc. of the internship) closing report
• Pre and Post Survey to be completed by the student
• Supervisor must submit Work Based Learning Plan at the completion of internship

Prior to payment disbursements the following must be completed and submitted to Talia Landry, ARP-AIRE Grant Manager, CC Admin Assistant; Sassamin Weeden:
• Agreed hours Intern Hours with Company listed above
• Time records submitted every 35 hours (signed by supervisor with supervisor report)
• Completed pre and post surveys Final Payment Requirements
• Completed Supervisor Work Based learning plan
• Post internship survey
• Final essay

Compensation/Pay:
$15.00 per hour = $1500 (3 $500 Payments)

Intern/Student Signature*

Supervisor Signature*

Parent/Guardian Signature (if under 18)

Parent/Guardian Details

Parent/Guardian Name*

Address*

Same as Student Address

Street Address City State ZIP Code

Phone*

Email*

Emergency Contact

Name*

Relationship*

Phone*

Name

This field is for validation purposes and should be left unchanged.

Mashpee Wampanoag Tribe
Education Department

483 Great Neck Road South
Mashpee, MA 02649

508-477-0208 x8

[email protected]

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