Hunter College Human Biology In-Person Internship/Independent Study Request Form

Human BiologyHunter College Human Biology In-Person Internship/Independent Study Request Form

Please provide information about your internship/independent study to the Human Biology Program Director.

Your name Your name * First Last
Email *
EMPLID *
Institution of Internship *
Internship Institution Web Site
Spring, Summer, or Fall? *
Internship Supervisor's name Internship Supervisor's name * First Last
Internship Supervisor's Email *
Have you discussed this internship with your internship supervisor? *

Have you discussed this internship with your internship supervisor? Yes (great, because we will be asking them to fill out a form like this one) No (so please go talk to them before submitting this form)
How did you find this internship? *
Please supply a 2 paragraph description of the internship, its educational nature, and its relationship to your Hum Bio major. *
Maximum of 500 words allowed. Currently Entered: 0 words.
How many hours will you complete for this internship during the semester (June-August for Summer, late August-December for Fall, late January-May for Spring): *
Is there any additional information that you wish to provide regarding this internship?
Maximum of 200 characters allowed. Currently Entered: 0 characters.
You will be required to fill out a similar online form later in the semester to provide information about your internship and its relationship to Hum Bio. *

You will be required to fill out a similar online form later in the semester to provide information about your internship and its relationship to Hum Bio. I agree to send this online evaluation in a timely manner. I do not agree
Once your supervisor confirms your internship and your Hum Bio advisor approves it, you will be required to enroll in a course for this internship, HMBIO40303 (3 credits), 40302 (2 credits), or 40301 (1 credits). *

Once your supervisor confirms your internship and your Hum Bio advisor approves it, you will be required to enroll in a course for this internship, HMBIO40303 (3 credits), 40302 (2 credits), or 40301 (1 credits). Yes I understand and agree. I do not understand.
I understand that my supervisor must fill out an evaluation at the end of the semester AND that I must do a self evaluation report at the end of the semester, in order to receive a letter grade and credit. Otherwise, an F grade or NC will be given. *

I understand that my supervisor must fill out an evaluation at the end of the semester AND that I must do a self evaluation report at the end of the semester, in order to receive a letter grade and credit. Otherwise, an F grade or NC will be given. Yes I understand and agree. I do not understand.
In signing this Agreement, I acknowledge that I understand that my participation in an in-person internship will involve risks and hazards not found in remote study at the College, which is the current mode of instruction required by the COVID-19 pandemic and the executive orders and directives of New York State. In ordinary times, these risks can range from a) minor injuries and illness such as bruises, and strains, to b) major injuries and illness such as broken limbs, loss of sight, neck or back injuries, heart attacks, and concussions, to c) catastrophic injuries, including paralysis and death, and also include risks of damage to or theft of personal property, and risks involved in traveling to and within, and returning from, internship sites. I understand that COVID-19 presents unique health risks, especially to those with underlying conditions, and that there may be other risks not known or reasonably foreseeable. I have sought and obtained information and advice that I feel are necessary and appropriate. I VOLUNTARILY ACCEPT AND ASSUME ALL OF THE RISKS IN PARTICIPATING IN THE INTERNSHIP and my participation in an internship with internship partner described below is voluntary. *

In signing this Agreement, I acknowledge that I understand that my participation in an in-person internship will involve risks and hazards not found in remote study at the College, which is the current mode of instruction required by the COVID-19 pandemic and the executive orders and directives of New York State. In ordinary times, these risks can range from a) minor injuries and illness such as bruises, and strains, to b) major injuries and illness such as broken limbs, loss of sight, neck or back injuries, heart attacks, and concussions, to c) catastrophic injuries, including paralysis and death, and also include risks of damage to or theft of personal property, and risks involved in traveling to and within, and returning from, internship sites. I understand that COVID-19 presents unique health risks, especially to those with underlying conditions, and that there may be other risks not known or reasonably foreseeable. I have sought and obtained information and advice that I feel are necessary and appropriate. I VOLUNTARILY ACCEPT AND ASSUME ALL OF THE RISKS IN PARTICIPATING IN THE INTERNSHIP and my participation in an internship with internship partner described below is voluntary. Yes I acknowledge the risks and hazards I do not acknowledge the risks and hazards
Draw your signature into the box below to confirm your entries. *

Draw or Type

I understand this is a legal representation of my signature. Clear

Full Name

I understand this is a legal representation of my signature.