FILLABLE FIS STUDENT- SUPERVISOR INTERNSHIP AGREEMENT.DOCX

FIS Student / Coordinator / Supervisor Internship Agreement
This Agreement is made on (“Date”) by and between
(“Internship
Site”) and the West Virginia University Board of Governors on behalf of West Virginia University and its
Program of Forensic & Investigative (“WVU”), and (“Student”)
(hereinafter referred to collectively as the “Parties”).
This Agreement is made solely for the purpose of Student’s for-credit Internship at Internship
Site. No other relationship, partnership, responsibilities, or rights are created, implied, or affirmed by
this Agreement.
This Agreement will be effective from (“Start Date”) to
(“End Date”) for (“Hours”) of Internship activity.
Upon completion of the Internship, including expectations defined below, Student will earn
[insert number] semester hours at WVU in [insert course descriptor and number] for the
semester of 20 (“Year”). Notwithstanding the foregoing, it is the Student’s responsibility to seek
academic credit from my college for participation in the Program. OME does not control eligibility for
internship credit
A.WVU Agrees to the Following Responsibilities:
1. WVU will provide an Academic Internship Coordinator, Martin Overly, who will consult
periodically with the Student to help the Student process the Internship experience and monitor
the Student’s progress.
2. The Academic Internship Supervisor will establish expectations, articulated below, for
requirements the student will fulfill to earn academic credit for the Internship.
3. The Academic Internship Supervisor and the Eberly College will notify the Student of the
necessity of adhering to the administrative policies, standards, and practices at the Internship
Site.
4. The Academic Internship Supervisor will assume responsibility for the assignment of a final
grade for the Internship experience.
1/2014

B.The Internship Site Agrees to the Following Responsibilities:
1. The Site will assign an Internship Site Supervisor who will oversee the Student during the
Internship.
2. The Site will provide a planned, supervised program of activities for the Student, with
opportunities for the Student to engage in a variety of activities so as to assure the opportunity
for professional development and adequate evaluation of the Student’s level of professional
competence.
3. The Internship Site Supervisor will establish with the Student a structured plan for periodic
discussion of assignments, goals, and insights related to professional development.
4. The Internship Site Supervisor or Site designee will provide one written evaluation(s) of the
Student and to be willing to personally discuss the evaluation with the Academic Internship
Supervisor should the need arise. If the student is performing an Internship in a forensic
discipline that is outside the scope of the evaluation (e.g., questioned documents, firearms
examination) the supervisor agrees to provide their own supplementary document evaluating
the specific tasks of the student.
5. The Internship Site Supervisor or Site designee will sign the Internship Verification Form
provided by the Student at the end of the Internship and return the form to the Academic
Internship Supervisor per directions accompanying the Verification Form.
6. The Site reserves the right to dismiss from the Internship any student whose conduct, work, or
health status may have a detrimental effect on Site staff or clients. If the Student’s Internship is
terminated prior to its conclusion for any reason, a meeting will occur between the Student, the
Academic Internship Supervisor, the Internship Site Supervisor, and other interested parties to
discuss the dismissal.
7. The Site agrees to provide an orientation to the Student that includes instruction on specific
rules, regulations, policies, procedures and ethical standards of professional practice within the
organization.
The terms above reflect the minimal expectations of the Internship experience. On occasion,
special circumstances will require some modification of the Agreement terms. If the Internship Site
Supervisor believes there are special circumstances that would require modification of this Agreement,
please state these modifications in the space provided below:
The Student shall sign Addendum 1 and the Student Acknowledgement agreeing to the additional terms and
conditions incorporated therein. Commented [BVDS1]: Added by our legal department
1/2014

C.The Student Agrees:
1. To act in accordance with the highest ethical standards of professional practice as defined by
the relevant practices, policies, rules, or regulations within the Site organization, as well as the
WVU Student Conduct Code and all other applicable University policies, rules, or regulations.
2. To establish with the Internship Site Supervisor at the outset of the Internship a schedule for
activities and attendance including starting, ending, and vacation dates.
3. To establish with the Internship Site Supervisor a structured plan for periodic discussion of
assignments, goals, and insights related to professional development, and to schedule the
number of required individual sessions at the convenience of the assigned Internship Site
Supervisor.
4. To log all hours spent at the Internship Site and notify the Academic Internship Coordinator if
the Student has difficulty or reason to believe there will be difficulty in meeting the needed
hours.
5. To notify the Internship Site Supervisor or other appropriate employee and the Academic
Internship Supervisor if the Student has any difficulty performing functions or establishing
satisfactory relationships with personnel at the site.
6. To only log hours when physically present at the Internship Site with the possible exception of
hours that are spent performing in-service training activities such as workshops, seminars, and
other training activities normally engaged in by professionals at the Internship Site.
7. To complete the requirements described below to earn academic credit. Materials will be
submitted at the conclusion of the Internship experience on or before [insert date] to the
Academic Internship Coordinator.
a. Prior to the start of the Internship the Student must sign the Internship Agreement and
the State of Risk, Responsibility, and Release Form. Materials must be submitted no later
than the end of the first Internship week.
b. During the Internship the Student will maintain a daily activity log. The log must be
summited to the Academic Internship Coordinator by Friday of the second week of the
following fall semester.
c. The Student will be responsible for ensuring the Self-Evaluation Form (Biology, Chemistry
or Examiner) and the Supervisor’s Task Report (Biology, Chemistry or Examiner) are
completed and submitted to the Academic Internship Coordinator. All materials must be
received by Friday of the second week of the following fall semester.
d. The Student will work with the Internship Site Coordinator to ensure the Site Evaluation
Form and the Internship Verification Form are submitted by the Site to the Academic
Internship Coordinator.
e. Students will be required to enroll in 494 Seminar. 1-3 HR. PR: Consent. Presentation
and discussion of mutual concern to students and faculty following the completion of
their summer experience.
Revised: January, 2011

D. The Parties Agree:
1. Indemnification. Each party (as "Indemnitor") agrees to defend, indemnify, and hold harmless the
other party (as "Indemnitee") from and against any and all claims, losses, liability, costs, or expenses
(including reasonable attorney's fees) (hereinafter collectively referred to as "Claims") arising out of
bodily injury of any person (including death) or property damage, but only to the extent that such
Claims result in vicarious/derivative liability to the Indemnitee and are caused by the act, omission,
negligence, misconduct, or other fault of the Indemnitor, its officers, officials, agents, employees, or
volunteers. Commented [BVDS2]: Added by our legal department
2. Nondiscrimination. The parties agree to comply with all applicable state and federal laws, rules,
regulations, and executive orders governing equal employment opportunity, immigration, and
nondiscrimination, including the Americans with Disabilities Act.
3. Conflict of Interest. Participation in this Agreement is subject to Section 38-511 of the Arizona
Revised Statutes which provides that this Agreement may be cancelled if any person significantly
involved in initiating, negotiating, securing, drafting or creating this Agreement on behalf of the
County is, at any time while this Agreement, or any extension thereof, is in effect, an employee or
agent of the other party to this Agreement in any capacity or a consultant to any other party with
respect to the subject matter of this Agreement.
4. Notice of Arbitration Statutes. Pursuant to Arizona Revised Statutes Section 12-1518, the parties
acknowledge and agree that they will be required to make use of mandatory arbitration of any legal
action that is filed in the Arizona superior court concerning a controversy arising out of this
Agreement if required by Section 12-133 of the Arizona Revised Statutes.
5. Student Educational Records. WVU and Site recognize that student educational records are
protected by the federal Family Educational Rights and Privacy Act (FERPA) (20 U.S.C. § 1232g).
FERPA permits disclosure of student “educational records” to “school officials” that have a
“legitimate educational interest” in the information.
6. Miscellaneous.
a. Neither party shall have the right to assign this Agreement without the prior written consent
of the other party.
b. This Agreement constitutes the entire agreement and understanding of the parties with
respect to its subject matter. No prior or contemporaneous agreement or understanding
will be effective. This Agreement shall be governed by the laws of Arizona, the courts of
which state shall have jurisdiction over its subject matter.
c. The individual signing on behalf of Site hereby represents and warrants that s/he is duly
authorized to execute and deliver this Agreement on behalf of Site and that this Agreement
is binding upon Site in accordance with its terms
d. This Agreement may be executed in multiple counterparts, each of which shall be deemed
an original, and all of which together shall constitute one and the same instrument.
Revised: January, 2011

The Parties have read and agree to the above statements and guidelines relevant to the program and
placement of this Student, and to the general provisions articulated in Addendum and Student
Acknowledgement attached hereto.
For West Virginia University For the Internship Site
Signature (Chair/Dean or Designee*) & Date Signature & Date
Printed Name/Title Printed Name/Title
Phone/E-mail Phone/E-mail
Academic Internship Supervisor Internship Site Supervisor
Signature & Date Signature & Date
Printed Name/Title Printed Name/Title
Phone/E-mail Phone/E-mail
Mailing Address Mailing Address
Student Agreement
I have read this Agreement carefully and agree to abide by it. I have had the opportunity to have
any questions pertaining to this Agreement answered. I also understand that this individual and specific
Agreement supersedes any other document or agreement regarding Internships distributed by the
academic program or college office.
Signature & Date Mailing Address
Printed Name Phone/E-mail
Student ID
* Chair/Dean/Designee: Retain an executed copy in the student’s department file until graduation.
Revised: January, 2011

Addendum 1
To implement and accomplish the above-stated commitments and objectives, the Parties agree to the
following:
1. Intellectual Property. The Parties do not intend that the activities performed under this MOU
will result in inventions or the creation of new intellectual property, but if any result, the
following will apply: Each party shall retain exclusive title and all rights to inventions, copyrights,
and other intellectual property arising from the conceptions or efforts of its employees or
consultants in performing under this MOU. The Parties do not intend that the activities
performed under this MOU will result in inventions or the creation of new intellectual property,
but if any result, the Parties will determine ownership on an as-needed basis. The Parties shall
remain the exclusive owner of their inventions, copyrights, trademarks, service marks, and other
intellectual property in existence prior to entering into this MOU.
2. Use of Trademarks. Neither party shall use any trademarks, trade name, logos, trade dress, or
other intellectual property of the other party without the express written approval of that party.
With respect to WVU, express written approval must be granted by Trademark Licensing
Services.
3. Notices. Any written notice required by this agreement will be sent to: Eberly College of Arts and
Sciences, Undergraduate Studies Office, PO Box 6287, West Virginia University Morgantown, WV
26506-6287. Briana Van Der Schaaf, Maricopa County Forensic Science Center, 701 W Jefferson
St, Phoenix, AZ 85007.
4. Authority. The parties signing the agreement hereby represent and warrant that they are fully
authorized to execute this Agreement without obtaining the consent of any third party.
5. Applicable Law. This agreement will be governed in accordance with the laws of the state of
.
6. FERPA. The Parties agree to maintain the confidentiality of student records pursuant to the
Family Education Rights and Privacy Act (“FERPA”), 20 U.S.C. §1232g. Commented [BVDS3]: Removed by our legal department
7.5.Equal Opportunity. The Parties agree that, as an essential proposition to any cooperative
endeavor, all participants in programs created pursuant to this agreement will be selected with
equal opportunity for all persons in accordance with the policies of each party and without
regard to the race, sex, age, national origin, religious affiliation, disability, veteran status, color,
sexual orientation, or ancestry of participants or candidates for participation.
Revised: January, 2011

MARICOPA COUNTY MEDICAL EXAMINER’S INTERNSHIP PROGRAM
ACKNOWLEDGMENT FORM
By signing this form, I, __________________________________________, acknowledge the following:
1. I am volunteering my services to Maricopa County and the Maricopa County Office of the Medical
Examiner (together “OME”) by way of my participation in the Maricopa County Internship Program (the
“Program”) without expectation of compensation or benefits.
2. The Program is approximately __ weeks, for a minimum of ___ hours per week, beginning
______________, 20__ and concluding ______________, 20__.
3. In order to successfully complete the Program, I am required to participate for the duration of the term of the
Program.
4. It is my responsibility to seek academic credit from my college for my participation in the Program. OME
does not control eligibility for internship credit.
5. If I fail to comply with any rules, regulations, policies, or procedures of OME, such failure may result in
disciplinary action, up to and including dismissal from the Program.
6. Transportation to and from the Program is my sole responsibility, and shall not be the responsibility of
OME.
7. I am responsible for maintaining my own health insurance throughout the entire term of my participation in
the Program.
8. I am not an employee of OME and therefore am not entitled to any compensation from OME or benefits
normally associated with employment with OME, such as, but not limited to, wellness programs, paid leave
accrual, commuter benefits, and health, behavioral health, pharmacy, vision, dental, life, and short term
disability insurance programs. Also, I will not be entitled to enroll in the Arizona State Retirement System
or Maricopa County’s deferred compensation retirement plan as a result of my participation in the Program.
Notwithstanding the foregoing, pursuant to A.R.S. §23-901.06, I understand that as an Intern, I will be
covered by and subject to the County’s workman’s compensation insurance coverage.
9. My internship is at will, terminable at any time, and participation in or completion of the Program does not
entitle me to a job with the County or any of the protections afforded by A.R.S. § 11-351 et seq. (Arizona
laws governing county employee merit systems) or the Maricopa County Employee Merit System.
10. I understand that I may be exposed to confidential information while participating in the Program and I
agree to respect the confidential nature of all information whether in hardcopy or electronic form which may
be revealed to me in any manner. I also agree not to remove such information via copies or by other
recording means from OME work locations.
Signature: _______________________________________________ Date: ____________________
Print Name: ______________________________________________
Revised: January, 2011