Winter Internship Funding Agreement

Section 1: Student Contact Information

Section 2: Internship Contact Information

If self-designed project, please enter "NA" in each field, and your e-mail address in the e-mail field.


Section 3: Internship Agreement

As an intern, I agree to carry out the responsibilities designated by my sponsor to the best of my abilities and to pursue completion of individual learning objectives. In addition, I reaffirm my understanding of and agreement to the conditions for receiving internship funding through Middlebury College:

a) Participating in this internship as described in my funding application. I agree to notify the Center for Careers & Internships should the length of my internship and/or my responsibilities change.

b) Completing and submitting electronically by February 13 the following:

  • an internship evaluation
  • a supervisor evaluation
  • reflections during the course of the internship as requested by the Center for Careers & Internships
  • a letter to the donor(s) according to guidelines that will be provided

These documents, in part or their entirety, will be made available to students, the selection committee, the award providers, college faculty, and staff.

c) Promoting participation in internships and internship funding to other students (e.g., panel discussion, social media, etc.) throughout the academic year.

I understand that, pending fulfillment of requirements, I will receive the award amount as follows:

Payment of the full amount in early December.

By your initials below, you acknowledge that you have reviewed this section and have agreed to these provisions

Section 5: Assumption of Risk and Code of Conduct

THIS IS A RELEASE OF LEGAL RIGHTS - READ CAREFULLY BEFORE SIGNING In consideration of Middlebury College's agreement to enable me to engage in this Internship, the receipt and sufficiency of which is hereby acknowledged, I agree as follows:

Risk of an Internship

• I understand that participation in the Internship involves risks not found in study at Middlebury College. These include risks involved in traveling to and within, and returning from Internship locations; foreign political, legal, social, and economic conditions; different standards of design, safety and maintenance of buildings, public places, and conveyances; and local medical and weather conditions.

• The location in which I perform the Internship may have health and safety standards different from those enjoyed at Middlebury College and I recognize that I may be subjected to potential risks, illnesses, injuries, and even death.

• I have made my own investigation of these risks, understand these risks and assume them knowingly and willingly.

• I also acknowledge that in working, living, and traveling in other cities and abroad, I may experience problems associated with urban living, including increased crime, pollution, high population density, or standards of living and health standards that are not equivalent to life at Middlebury College.

• I must take every precaution to safeguard my health and to protect my personal belongings from damage or theft.

• I acknowledge that Middlebury College recommends that I never travel alone, particularly at night. Being alone, particularly at night, may present additional danger to my safety and well-being.

Health Insurance and Medical Care:

• I agree to enroll in such medical insurance coverage program as is designated by Middlebury College for the duration of the Internship.

• I carry valid and current medical insurance and have a valid insurance identity card to bring.

• I have determined that this insurance is adequate to cover injuries or illnesses that I may sustain while performing the Internship, including the expenses of returning me to the United States in the event that such action is necessary.

• I certify that I am free of any conditions that would endanger my life, health, or well-being while working, traveling or living elsewhere, or that would impede my ability to fully participate in all aspects of the Internship.

• I recognize that Middlebury College is not obligated to attend to any of my medical or medication needs, and I assume all risk and responsibility therefore.

• If I require medical treatment or hospital care during the Internship, Middlebury College is not responsible for the cost or quality of such treatment of care. However, each of Middlebury College and its representatives and designees is authorized (but is not obligated) to take any actions it considers to be warranted under the circumstances regarding my health and safety, including but not limited to, placing me under the care of a doctor in a hospital or any other appropriate place for medical examination and/or treatment or returning me to the United States at my own expense if such return is deemed appropriate or necessary.

• I agree to pay all expenses relating thereto and release each of such persons from any liability for any such actions. Should the need arise, Middlebury College is authorized to provide any personal information about me to any health care provider.

Standards of Conduct:

• I understand that I will be responsible for my personal safety at all times.

• I recognize that I assume an important personal obligation to conduct myself in a manner compatible with local laws and regulations, and with Middlebury College regulations for student conduct.

• I promise to act responsibly and will become informed of, and will abide by, all such laws, regulations and standards.

• I will comply with Middlebury College's rules, standards and instructions for student behavior. I agree that Middlebury College has the right to enforce the standards of conduct described above, in its sole judgment, and that it will impose sanctions on me for violating these standards or for any behavior detrimental to or incompatible with the interest, harmony and welfare of Middlebury College or the Internship.

• I agree that if my Internship is terminated, I will be solely responsible for all expenses incurred up to the time of termination and for all expenses incurred in returning to my point of origin. • I also recognize that due to the circumstances of any international internship program, procedures for notice, hearing and appeal applicable to student disciplinary proceedings at Middlebury College do not apply.

Institutional Arrangements:

• I understand that Middlebury College does not represent or act as an agent for, and cannot control the acts or omissions of, any host employer, transportation carrier, hotel, motel, tour organizer or other provider of food, goods or services involved in the Internship.

• I understand that Middlebury College is not responsible for matters that are beyond its control. I hereby release Middlebury College from any injury, loss, damage, accident, delay or expense arising out of any such matters.

Independent Activity:

• I understand that Middlebury College is not responsible for any injury or loss I may suffer when I am traveling independently.


I further agree that:

a) If traveling to a foreign country for this Internship, I have a valid passport; if I do not have a U.S. passport, I have made sure that I either do not need a visa in connection with the Internship or I have obtained an entry visa; and

b) I am solely responsible for any legal problems I encounter with any foreign nationals or government of the host country. I acknowledge that:

1. Middlebury College is not able to assist students who break the law in a foreign country and is not responsible for legal fees or other costs while attempting to secure my release from foreign custody, and

2. Neither Middlebury College nor the United States government has the ability to protect me from punishment with respect to drugs and other criminal offenses.

Assumption of Risk and Release of Claims:

Knowing the risks described above, I agree, on behalf of my family, heirs and personal representative(s), to assume all the risks and responsibilities surrounding my participation in the Internship. To the maximum extent permitted by law, I release, hold harmless and agree to indemnify Middlebury College, its Board of Trustees, and its officers, faculty, staff, representatives, volunteers, employees and agents, from and against any present or future claim, loss or liability for injury to person or property which I may suffer, or for which I may be liable to any other person, during my participation in the Internship (including periods in transit to or from any location and/or country where the Internship may be taking place), resulting from any cause including but not limited to Middlebury College's, its Trustees', officers', faculties', staffs', representatives', volunteers', employees', or agents' own passive or active negligence or other acts other than fraud, willful misconduct or violation of the law.

By your initials below, you acknowledge that you have reviewed this section and have agreed to these provisions

Section 6: IRB: The Institutional Review Board

If you are doing research that involves working with living human beings, you may need to get permission from the IRB before you begin.

By your initials below, you acknowledge that you have reviewed this section and have agreed to these provisions

Please double-check that you have initialed all boxes and then click "submit". Thank you.

Center for Careers & Internships

Middlebury College
Middlebury, Vermont, 05753
Phone: (802) 443-5100