Return to Student Life Site Banner cci_banner.jpg Center for Careers & Internships CCI Home Alumni General Events Health Professions Internships Academic Sponsor Approval Form Application for First-Year Explore Grants Application for Winter Term Arts Internship Funding Application for Winter Term CCCS Internship Funding Application for Winter Term Internship Funding Assumption of Risk and Code of Conduct Fieldwork Enrollment Application Intern Sponsor Agreement Intern Supervisor Evaluation New Millennium Fund Sponsor Application Pre-funded Internship Self-Directed Project Evaluation Form Summer Cohort Self-Evaluation Summer Intern Self-Evaluation Winter Intern Self-Evaluation Winter Internship Funding Agreement Winter Term Intern Supervisor Evaluation Recruiting Site Editor Log On Home » Student Life » Center for Careers & Internships » Internships » Intern Sponsor Agreement Intern Sponsor Agreement To be completed by the Internship Supervisor Student First Name * Student Last Name * Internship Information Your First Name (Intern Supervisor) * Your Last Name (Intern Supervisor) * Your Title * Your Organization * Street Address * City * State - None -AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarshall IslandsMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Marianas IslandsOhioOklahomaOregonPalauPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirgin IslandsVirginiaWashingtonWest VirginiaWisconsinWyoming Zip Code * Country * - Select -United States----------AfghanistanÅland IslandsAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua/BarbudaArgentinaArmeniaArubaAustriaAustraliaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBosnia/HerzegovinaBotswanaBouvet IslandBrazilBrunei DarussalamBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos (Keeling) IslandsColombiaComorosCongoCook IslandsCosta RicaCôte D'IvoireCroatiaCubaCyprusCzech RepublicDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEthiopiaFalkland Islands(Malvinas)Faroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island/Mcdonald IslandsHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle Of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKuwaitKyrgyzstanLaoLatviaLebanonLesothoLiberiaLibyan Arab JamahiriyaLiechtensteinLithuaniaLuxembourgMacaoMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNetherlands AntillesNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth KoreaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestinePanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRéunionRomaniaRussian FederationRwandaSt. BarthélemySt. HelenaSt. Kitts/NevisSt. LuciaSt. MartinSt. Pierre/MiquelonSt. Vincent/The GrenadinesSamoaSan MarinoSao Tome/PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia/Sandwich IslandsSouth KoreaSpainSri LankaSudanSurinameSvalbard/Jan MayenSwazilandSwedenSwitzerlandSyrian Arab RepublicTaiwanTajikistanTanzaniaThailandTimor-LesteTogoTokelauTongaTrinidad And TobagoTunisiaTurkeyTurkmenistanTurks/Caicos IslandsTuvaluUgandaUkraineUnited Arab EmiratesUnited KingdomUnited States Minor IslandsUruguayUzbekistanVanuatuVatican City StateVenezuelaViet NamVirgin Islands, BritishVirgin Islands, U.S.Wallis/FutunaWestern SaharaYemenZambiaZimbabwe Phone Number * Your e-mail Address * Website address * Brief description of intern responsibilities * Anticipated Start Date * Month MonthJanFebMarAprMayJunJulAugSepOctNovDec Day Day12345678910111213141516171819202122232425262728293031 Year Year20192020202120222023 Anticipated End Date * Month MonthJanFebMarAprMayJunJulAugSepOctNovDec Day Day12345678910111213141516171819202122232425262728293031 Year Year20192020202120222023 AgreementAs a sponsor, I affirm that the student named above will serve as an intern with my organization or project. I agree to provide adequate supervision/mentoring and support so that the intern may carry out agreed upon responsibilities. I will ensure a safe and productive working environment that fosters professionalism and ethical conduct. If this is a Winter Term internship and the student will be receiving credit from Middlebury College, I affirm that this is an unpaid internship. I will provide Middlebury College with an evaluation of the intern’s performance at the end of internship period. I have read and accept the above. In lieu of a signature, please type your name * Leave this field blank Center for Careers and Internships Middlebury CollegeMiddlebury, Vermont 05753Phone: (802) 443-5100E-mail
Intern Sponsor Agreement To be completed by the Internship Supervisor Student First Name * Student Last Name * Internship Information Your First Name (Intern Supervisor) * Your Last Name (Intern Supervisor) * Your Title * Your Organization * Street Address * City * State - None -AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarshall IslandsMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Marianas IslandsOhioOklahomaOregonPalauPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirgin IslandsVirginiaWashingtonWest VirginiaWisconsinWyoming Zip Code * Country * - Select -United States----------AfghanistanÅland IslandsAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua/BarbudaArgentinaArmeniaArubaAustriaAustraliaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBosnia/HerzegovinaBotswanaBouvet IslandBrazilBrunei DarussalamBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos (Keeling) IslandsColombiaComorosCongoCook IslandsCosta RicaCôte D'IvoireCroatiaCubaCyprusCzech RepublicDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEthiopiaFalkland Islands(Malvinas)Faroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island/Mcdonald IslandsHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle Of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKuwaitKyrgyzstanLaoLatviaLebanonLesothoLiberiaLibyan Arab JamahiriyaLiechtensteinLithuaniaLuxembourgMacaoMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNetherlands AntillesNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth KoreaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestinePanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRéunionRomaniaRussian FederationRwandaSt. BarthélemySt. HelenaSt. Kitts/NevisSt. LuciaSt. MartinSt. Pierre/MiquelonSt. Vincent/The GrenadinesSamoaSan MarinoSao Tome/PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia/Sandwich IslandsSouth KoreaSpainSri LankaSudanSurinameSvalbard/Jan MayenSwazilandSwedenSwitzerlandSyrian Arab RepublicTaiwanTajikistanTanzaniaThailandTimor-LesteTogoTokelauTongaTrinidad And TobagoTunisiaTurkeyTurkmenistanTurks/Caicos IslandsTuvaluUgandaUkraineUnited Arab EmiratesUnited KingdomUnited States Minor IslandsUruguayUzbekistanVanuatuVatican City StateVenezuelaViet NamVirgin Islands, BritishVirgin Islands, U.S.Wallis/FutunaWestern SaharaYemenZambiaZimbabwe Phone Number * Your e-mail Address * Website address * Brief description of intern responsibilities * Anticipated Start Date * Month MonthJanFebMarAprMayJunJulAugSepOctNovDec Day Day12345678910111213141516171819202122232425262728293031 Year Year20192020202120222023 Anticipated End Date * Month MonthJanFebMarAprMayJunJulAugSepOctNovDec Day Day12345678910111213141516171819202122232425262728293031 Year Year20192020202120222023 AgreementAs a sponsor, I affirm that the student named above will serve as an intern with my organization or project. I agree to provide adequate supervision/mentoring and support so that the intern may carry out agreed upon responsibilities. I will ensure a safe and productive working environment that fosters professionalism and ethical conduct. If this is a Winter Term internship and the student will be receiving credit from Middlebury College, I affirm that this is an unpaid internship. I will provide Middlebury College with an evaluation of the intern’s performance at the end of internship period. I have read and accept the above. In lieu of a signature, please type your name * Leave this field blank
Center for Careers and Internships Middlebury CollegeMiddlebury, Vermont 05753Phone: (802) 443-5100E-mail