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The School Board of Miami -Dade County, Florida
Internship Cooperative Agreement
THIS COOPERATIVE AGREEMENT "Agreement" is entered into this , 20,
by and between , ("Entity Name" Must be the same as
listed at Florida Department of State Division of Corporations), and The School Board of Mlami-Dade
County, Florida, (" M-DCPS"), a political subdivision of the State of Florida.
Internship Provider
Entity Name:
Mentor Name:'
Address:
City;/ State / Zip:
Telephone / Fax:
Email:
Program status (check one):
Public El Private Non-profit ® Private For -profit
Government / Municipal / State / Federal
'(he School Board of Miami -Dade County, Florida
Name: Miami -Dade County Public Schools / Office of CoJmmunity Engagement
Address: 1450 N.E. 2nd Avenue, Suite 202
City / State / Zip: Miami, FL 33132
Telephone / Fax: 305-995-3050 / 305-995-2888
Email: asmartinez@dadeschools.net
I. RECITALS
1. M-DCPS and Business Mentor want to provide M-DCPS senior high students with an
appropriate internship program Career Experience Opportunity (CEO) or Honors and
Executive Internship Program (HEIP) program to reinforce acquisition of employability
skills; and
2. M-DCPS and Business Mentor want M-DCPS senior high students, "interns", to receive
the related and support services necessary to obtain skills, experience, and knowledge to
maximize employment opportunities.
NOW, THEREFORE, in consideration of the premises and the mutual covenants and agreements herein
contained, and other good and valuable consideration, the receipt of which is hereby acknowledged, the
parties hereto agree as follows:
II. RESPONSIBILITIES OF M-DCPS
M-DCPS agrees:
• To provide support for the internship experience as provided for in the Miami -Dade
County Public Schools respective internship guide;
• To arrange any meetings with school, regional center, or district -based personnel, as
deemed necessary to the functioning of the program;
• To maintain appropriate documentation and application of interns;
• To select interns from eligible pool of students;
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• To provide an orientation program for interns and Business Mentor; 1'1 U
• To provide on -site visitations for support and monitoring by M-DCPS staff, dap it.thrw
111. RESPONSIBILITIES OF BUSINESS MENTOR
Business Mentor agrees:
• to provide internship experience(s) for selected M-DCPS students as specified in the
Miami -Dade County Public Schools respective internship guide;
• to provide the necessary assements or evaluation as outlined in the internship guide;
• to maintain attendance records / log sheet on -site and inform M-DCPS / Office of
Community Engagement immediately via phone and/or email of unscheduled absences;
• . to assure the safety of the interns while under their supervision;
• to ensure students will intern only at the given place of business (no home based
businesses or secondary sites are allowed).
• to provide M-DCPS with a current set of its rules, regulations, and policies that directly
affect the interns placed at the business site. Business Mentor shall acquaint the students
with rules, regulations, and policies.
Business Mentor reserves the right to refuse its services or to remove from its facilities any interns or M-
DCPS employee who does not meet professional or other requirements of Business Mentor.
IV. PARTIES AGREE THAT:
A. RESPONSIBILITIES OF BOTH PARTIES
1. The schedule for interns while on -site at Business Mentor shall be planned jointly
by M-DCPS, the Business Mentor and the student. Any changes in the schedule
must be approved by all parties prior to implementation of a new schedule.
2. M-DCPS and Business Mentor shall both designate an individual who shall be
available to answer all questions and assist in the implementation of this
Agreement.
3. M-DCPS and Business Mentor agree that the students covered by the terms of this
agreement are not Business Mentor's employees for the purpose of the Fair Labor
Standards Act, as evidenced by the following;
a. The training, even though it includes actual operation of the facilities of
Business Mentor, is similar to that which would be given in a school;
b. The training is for the benefit of the interns;
c. The interns do not displace regular employees, but work under their close
observation;
d. Business Mentor, in providing the site for the program, derives no immediate
advantage from the activities of the interns;
e. The interns are not necessarily entitled to jobs at the conclusion of the
training period; and
f. The interns are not entitled to wages for the time spent in training in the
program.
B. TERM OF AGREEMENT; TERMINATION
The term of this Agreement shall be from , 2n , and can be
valid for up to three (3) years, through and including June 30, 20(15 16 17). Either party
hereto may terminate this Agreement at any time by giving to the other party notice in
writing at least 30 days prior to the intended termination date.
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C. COMPLIANCE WITH LAW
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1. M-DCPS and Business Mentor agree to comply with Title VI of the Civil Rights Act of
1964, Title VII of the Civil Rights Act of 1964, Title IX of the Education Amendments
of 1972, Section 504 of the Rehabilitation Act of 1973, the Fair Labor Standards Act,
the Americans with Disabilities Act, and related regulations, and assure that they do
not, and Will not discriminate against any intern because of or on the basis of gender,
race, color, religion, ethnic or national origin, political beliefs, marital status, age,
sexual orientation, social and family background, linguistic preference or disability.
2. Business Mentor agrees to adopt a background screening process that is consistent
with having interns in the workplace, and consistent with M-DCPS guidelines.
3. This agreement shall be subject to Florida's Public Record Laws, Chapter 119,
Florida Statutes.
D. NO THIRD PARTY BENEFICIARIES
The parties expressly acknowledge that it is not their intent to create or confer any rights
or obligations in or upon any third person or entity under this Agreement. Nothing herein
shall be construed as consent by an agency or political subdivision of the State of Florida
to be sued by third parties in any matter arising out of any contract.
E. CONFIDENTIALITY OF STUDENT INFORMATION
Business Mentor understands and agrees that it is subject to all applicable federal and
Florida laws and all School Board policies relating to the confidentiality of student
records. Business Mentor further agrees to comply with the Federal Family Educational
Rights and Privacy Act ("FERPA" 34CFR§ 99) and shall (i) use any personally identifiable
student Information ("information") only as provided In this Agreement, (ii) maintain the
confidentiality of the information and, (iii) return the information to the Agency upon
termination of the Agreement. Business Mentor shall treat all information as confidential
and will not disclose the information to any third party.
F. INSURANCE
M-DCPS and the Business Mentor agree to insure or self -insure their respective interests
to the extent each deem necessary or appropriate. Upon written request, evidence of self
insurance or insurance shall be furnished to either party.
G. INDEMNIFICATION
Indemnities (as hereinafY dried) against any ciai
injury, ility, cost or ex • nse of .ever kind or
way of lime `•n, att• eys fees and cou .osts
property damage : +: ing out of or incidental t+ -
Agreement by • on be. = of h B
to be inde r ties The Sc
members .fFicers and employees.
indem►' the School Board f
per mance or failure of •-.
•
the Business entor.
:oar. f Miami -Dade
ever, nothing here
o -ny liabi r , or claim ar
ormance of the School
•
u re
ising out
negligent
following
n
mn3 y • - ens:
ion, loss, dam -
eluding, but
bodily, jury or
perf. , nee of this
I e deemed
Florida nd its
I be deem + to
ng out o neglige
oard .or as a result of the
u
tb
The School Board of Miami -Dade County, Florida does hereby agree to hold
harmless and indemnify the Business Mentor to the extent of limitations included
within Florida Statutes, Section 768.28, subject to the provisions in this act whereby
the School Board shall not be held liable to pay a personal injury claim or property
damage claim or judgment by any one person which exceeds the sum of $200,000,
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4-
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or any claim or judgments or portions thereof, which, when totaled with all other
claims or judgments paid by the School Board arising out of the same incident or
occurrence, exceeds the sum of $300,000 from any and all personal injury or
property claims, liabilities, losses and causes of actions arising out or incidental to
the negligent performance of this Agreement. However, nothing herein shall be
deemed to indemnify the Business Mentor for any liability or claim arising out of the
negligent performance or failure of performance of the Business Mentor or as a
result of the negligence of any unrelated third party.
I-1, MODIFICATION
This Agreement may be modified or amended only in writing by mutual consent of both
parties.
GOVERNING LAW AND VENUE
This agreement shall be construed in accordance with the laws of the State of Florida.
Any dispute with respect to this agreement is subject to the laws of Florida, venue in
Miami -Dade County. Each party shall be responsible for its own attorneys' fees and
costs incurred as a result of any action or proceeding under this agreement
J. NOTICES
All notices or communication under this Agreement by either party to the other shall be
sufficiently given or delivered as follows:
In the case of notice or communication to Business Mentor:
Name/Title:
If designee, you must be authorized to sign on behalf of the entity.
Company:
Address:
City, State & Zip:
Phone:
Email:
In the case of notice or communication to M-DCPS:
Miami -Dade County Public Schools
Office of Community Engagement
1450 N.E. 2nd Avenue, Suite 202
Miami, FL 33132
305-995-3050
With a copy to;
The School Board of Miami -Dade County, Florida
Attn: Alberto M. Carvalho, Superintendent
1450 N.E. 2nd Avenue, Suite 912
Miami, FL 33132
And a copy to:
The School Board of Miami -Dade County, Florida
Attn: Walter J. Harvey, School Board Attorney
1450. N.E. 2nd Avenue, Suite 430
Miami, FL 33132
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SIGNATORY FORM
IN WITNESS HEREOF THE PARTIES HERETO HAVE CAUSED TO 13E EXECUTED BELOW THE
SIGNATURES OF THE AUTHORIZED REPRESENTATIVES OF THE PARTIES HERETO WHO ARE
FULLY AND DULY AUTHORIZED TO EXECUTE THIS AGREEMENT ON BEHALF OF THE
RESPECTIVE PARTIES HERETO:
For: Employer
Program. Authorized Representative Name (Print)
Program Authorized Representative Signature
F:or: The School Board of Miami -Dade County, Florida
Alberto M. Carvalho
Title (Print)
Date
Superintendent's Name (Print) Superintendent's Signature
Approved as to Legal Form and Legal Sufficiency:
Date
Attorney for School Board of Miami -Dade County, Florida Date
Reviewed and Approved:
Risk Management 1 Miami -Dade County Public Schools
Date
Please return two (2) signed original copies to:
Miami -Dade County Public Schools
Office of Community Engagement
1450 N.E. 2nd Avenue, Suite 202
Miami, FL 33132
Page 5 of 5
Miami -Dade County Public Schools
Office of Community Engagement
THE SCHOOL BOARD OF
MIAMI-DADE COUNTY, FLORIDA
Ms. Perla Tabares Hantman, Chair
Dr. Lawrence S. Feldman, Vice Chair
Dr. Dorothy Bendross-Mindingall
Ms. Susie V. Castillo
Mr. Carlos L. Curbelo
Dr. Wilbert "Tee" Holloway
Dr. Martin Karp
Dr. Marta Perez
Ms. Raquel A. Regalado
Mr. Alberto M. Carvalho
Superintendent of Schools
Ms. Iraida R. Mendez-Cartaya
Associate Superintendent
Office of Intergovernmental Affairs, Grants Administration,
and Community Engagement
Ms. Lisa Thurber
District Director
Office of Community Engagement
Ms. Arlene Martinez
Director
Office of Community Engagement
Internship Program/Dade Partners
Table of Contents
Introduction 1
Credits &.Attendance 2
Becoming an Internship Provider 3
Roles & Responsibilities 4
Performance Evaluation 5
Program Calendar 201 4/201 5 6
Forms
Student Internship Application 7
Student Placement Data Form 8
Required Student Procedures
Intern Emergency Contact Sheet
9
10
Internship Log Sheet 11
INTRODUCTION
Since 1958, the Internship Program has provided exciting opportunities for high school
juniors and seniors in the Miami -Dade County Public Schools. Through a community -
based internship, students are paired with community professionals to gain professional
experience and firsthand knowledge in their intended collegiate fields of study.
Enthusiastic mentors participate in the program and share their time and talents so that
interns will have meaningful, career -related experiences.
The internship is designed to give students real -life experiences in the world -of
work. During this time, students will take on the roles and responsibilities of a
valued member of a business organization. It is important that the student
interns understand that their dress, punctuality, attendance, and behavior
reflect well upon themselves and their parents, teachers, schools, and peers.
The internship involves two individuals - an Educational Specialist and a Miami -
Dade County Public Schools (M-DCPS) administrator to oversee the intern. The M-
DCPS program staff oversees the internship, visits interns and internship providers,
and assists in a successful internship.
Thank you for providing our students with this experience, The Office of Community
Engagement is available for support. If there are any questions, problems,
concerns, or issues that arise, contact us at 305-995-1265 or
Internships@dadeschools,net.
1
CREDITS
To receive full credit for the internship program course, students must participate in
the required hours at their internship site and must complete required assignments.
• For one (1) credit, the minimum number of hours required is five (5) hours per
week or forty-five (45) hours for the quarter.
• For two (2) credits the student must complete ten (10) hours per week or
ninety (90) hours for the quarter.
ATTENDANCE
• The internship student confers with his/her internship provider to establish a
convenient time schedule. Internship providers and students are asked to be
flexible. As situations change, schedules may need to be adjusted. The schedule
must°Indicate the days of the week and the hours that the student will be at their
internship site.
• Students may not remain at their internship site after sundown, unless they have
permission from their internship provider and parent/guardian. Students usually
complete their hours during the regular school week.
• Regular attendance and punctuality are critical. Students should not miss
scheduled days at their internship site and should always arrive on time. If a
scheduled day is missed due to a Miami -Dade County Public Schools (M-DCPS)
excused absence, the student must inform the internship provider and mutually
determine an appropriate time to make up the missed hours. For example,
making up missed hours may be done by students attending their internship on
any day not regularly scheduled. All make-up hours must be scheduled with the
approval of the internship provider. The student must notify the internship
provider prior to any absence or late arrival to their internship site. Failure to do so
will affect the student's grade.
• Students are not required to attend their scheduled internship day if it falls on a
teacher planning day or holiday. However, the student may attend his/her
placement on that day if prior arrangements have been made with the
internship provider. Teacher planning days present a good opportunity to log
additional hours and/or hours at a time of day when different activities may
occur at the internship site.
• During an extended illness or absence, the student and internship provider may
make alternative arrangements. Students must notify their program
administrators of any changes in their schedule and/or outline of proposed
internship activities.
• Monetary compensation to the student is not permitted. Time spent at the
internship site may not be counted as volunteer or community service hours,
unless special arrangements are made to acquire those hours after the internship
requirement is fulfilled.
*M-DCPS excused absences: Student illness, death in the family, observance of religious
holiday, or school -sponsored event with prior approval by internship provider.
2
Becoming an Internship Provider
Step 1:
• Log In to Community Portal
• Click on "Create an Account"
• Proceed with "Registration Request"
• Your username and password will be e-mailed to you
Step 2:
• Return to www.dadeschools.net/community
• Log In to the Community Portal
• Log In.withyour username and password
• You can reset your password under "Password Management"
Step 3:
Click on "Internship Provider"
• Complete the "Internship Provider Application"
• You will receive an email with the steps for posting your internship positions once
your application has been approved.
3
Roles and Responsibilities:
As part of the registration process, the internship office will request that the internship
provider execute a Cooperative Agreement as part of the procedures to host an intern.
Visit http://communify.dadeschoois.net/linternship/pdfs/internship Cooperative Agreement.pdf
to see a copy of the Cooperative Agreement.
1. Cooperative Agreement
Cooperative Agreement must be signed by the registered agent. (The
registered Agent can be viewed in Sunbiz.org)
Two (2) original Cooperative Agreements must be submitted by mail.
Cooperative agreement cannot be faxed or emailed. (Cooperative
agreements faxed or emailed are not acceptable).
2. Review handbook to familiarize yourself with the forms:
• Student internship Application
• Student Data Placement Form (SPDF)- Confirming student's placement
• Required Student Procedures
■ Internship providers may customize this form to fit the goals of the
organization offering the internship.
■ Internship providers should review these procedures with
student/intern.
• Log Sheet Form. For student to log in their attendance, hours, and
program activities. Internship provider should check form periodically
and sign.
3. Students are not allowed to intern with a family member or participate in a
home -based business.
Your Role as an Internship Provider
As an internship provider you pass on valuable skills and knowledge to your intern.
• Teach organizational skills
• Develop achievable short-term and long-term goals
• Build positive values that will make the intern more successful
• Teach basic principles of personal and social responsibility
• Provide required evaluation every nine (9) weeks, as outlined in the handbook
(Log sheet and grade sheet)
4
Evaluation
• A grade/evaluation is required by the internship provider every nine (9) weeks.
The grade is based on the student's performance at their internship site and is
based on the such criteria as the student's:
a Attendance/Punctuality,
o Communication Skills
o Meets Deadlines
O Acquired/Learned Skills for internship
Every nine weeks, internship providers will be sent a Grade Request Report by the
Office of Community Engagement for providers to evaluate the student based
on the aforementioned criteria. Information about the Miami -Dade County
Public Schools grading system is provided on the Grade Request. Report. Please
return the completed Grade Request Report to the Office of Community
Engagement by the deadline indicated on the form.
If a student is not fulfilling his/her responsibilities or is not attending regularly,
please notify one of the program administrators in the Office of Community
Engagement at once, so that the situation can be rectified, It is vital that the
office be advised IMMEDIATELY of any breach of student responsibility. Please
contact us at 305 995-1265 or email internships@dadeschools.net,
• Miami -Dade County Public Schools is required to inform parents/guardians at
any time that a student's grade falls below acceptable. Therefore, if a student is
in danger of receiving a failing grade ("D" or "F"), please notify one of the
program advisors in the Office of Community Engagement IMMEDIATELY, so that
we may contact the parent/guardian of the student,
FORMS
• Student Internship Application (Form 7525)
• Student Data Placement Form (SPDF) - Form confirms intern's placement. Must be
returned immediately after interview with mentor,
• Required Student Procedures - This form is for students to understand their
responsibilities involved with the internship and must be turned in along with the
SPDF. This form must be reviewed by both internship provider and student; both
parties are required to sign the form.
• Intern Emergency Contact Information Sheet- This sheet must be submitted to
internship provider. Parent/guardian home, work, and cellular phone numbers
should be provided.
• Log Sheets- Form is for student to record their attendance and program activities
hours every time they attend the internship. The log sheet must be signed by
internship provider regularly. (Note it is the responsibility of the student to submit
the log sheet directly to our office by the deadline).
5
PROGRAM CALENDAR
August
18 - 22 First week of school/Students begin reporting to the internship site
September
1 Labor Day: Legal Holiday - NO SCHOOL
4 Teacher Planning Day - NO SCHOOL
October
13 Submit 1st Quarter Internship Log Sheet
23 Teacher Planning Day - NO SCHOOL
27 Beginning/End of Grading Period
November
7 Teacher Planning Day - NO SCHOOL
11 Veteran's Day: Legal Holiday -NO SCHOOL
27 Thanksgiving. Day: Legal Holiday - NO SCHOOL
27 Recess Day NO SCHOOL
December
22-30
Winter Recess
January
1 - 2 Winter Recess
5 Submit 2nd Quarter Internship Log Sheet
15 Beginning/End of Grading Period
16 Teacher Planning Day - NO SCHOOL
19 Dr, Martin Luther King, Jr, Holiday: Legal Holiday -NO SCHOOL
20 Beginning/End of Grading Period
February
6 Teacher Planning Day - NO SCHOOL
16 President's Day: Legal Holiday - NO SCHOOL
March
9 Submit 3rd Quarter Internship Log Sheet
20 Teacher Planning Day - NO SCHOOL
23 - 27 Spring Recess
April
17 Teacher Planning Day - NO SCHOOL
May
18- 22 LAST WEEK OF INTERNSHIP
22 Submit 4th Quarter Internship Log Sheet
25 Memorial Day: Legal Holiday - NO SCHOOL
Calendar Website: http://www.dadeschools.net/calendars/
6
FOR OCE OFFICAL USE ONLY:
GPA:
ATTENDANCE
MIAMI-DADE COUNTY PUBLIC SCHOOLS
OFFICE OF COMMUNITY ENGAGEMENT
1450 NE 2nd AVENUE, ROOM 202, MIAMI, FLORIDA 33132
PHONE: 305 995-1265 FAX: 305 995-2888
Internships@dadeschools.net
APPLICATION DEADLINE: FRIDAY, MARCH 14, 2014
INTERNSHIP APPLICATION (Must Be Typed)
STUDENT INFORMATION:
ID#: NAME: DATE OF BIRTH:
HOME ADDRESS: CITY/STATE/ZIP:
HOME: CELL: EMAIL:
ETHNICITY: Please check all that apply:
ASIAN BLACK ESOL GIFTED FREE or REDUCED LUNCH
HISPANIC INDIAN
MULTIRACIAL NATIVE AMERICAN GENDER (Please cheekane):
WHITE OTHER: MALE FEMALE
SCHOOL INFORMATION:
SCHOOL NAME: CURRENT GRADE:
GUARDIAN INFORMATION:
FATHER/GUARDIAN NAME: PHONE 1:
EMAIL: PHONE 2:
MOTHER/GUARDIAN NAME: PHONE 1:
EMAIL: PHONE 2:
COURSE INFORMATION:
PLEASE READ YOUR INTERNSHIP HANDBOOK TO CHOOSE YOUR
CAREER CHOICE:
1.
2.
INSURANCE:
MARK IF YOU HAVE PRIVATE INSURANCE OR HAVE PURCHASED SCHOOL INSURANCE (
SUBMIT PROOF );
PRIVATE INSURANCE
PURCHASED SCHOOL INSURANCE
3
COUNSELOR/FACULTY RECOMMENDATION: NAME: TITLE:
SIGNATURE:
IF YOU HAVE YOUR OWN MENTOR (NO FAMILY MEMBERS OR FRIENDS), FILL OUT THE FOLLOWING:
*PROPOSED MENTOR NAME:
COMPANY NAME: DEPARTMENT NAME:
ADDRESS: CITY/STATE/ZIP:
PHONE:
FAX: EMAIL:(required)
TYPE OF BUSINESS:
PARENT PERMISSION FORM & LIABILITY WAIVER (SUBMIT PROOF):
I have read the INTERNSHIP HANDBOOK; I understand and agree to the conditions that are required for
participation in the Internship Program. I give consent for my child to participate.
PARENT NAME:
PARENT. SIGNATURE:
STUDENT SIGNATURE:
FOR ELIGIBILITY AND COURSE REQUIREMENT REVIEW INTERNSHIP HANDBOOK
http://cornmunity.dadeschools.net/lInternshiplHE_overview.asp
Miami -Dade County Public Schools
Office of Community Engagement
Internship Program
1450 N.E, 2nd Avenue, Room 202
Miami, FL 33132
Tel: 305-995-1265/Fax:305-995-2888
E-mail: I riternships@dadeschools.net
Student Placement Data Form 2014 - 2015
INSTRUCTIONS
1. Call your proposed internship provider and make an appointment for an interview IMMEDIATELY.
Please return the SIGNED form to us as soon as possible. E-mail or call us if you have any problems.
2, If you need to leave a message for the internship provider, please let them know you are a Miami -Dade
County Public Schools student from the Internship Program (Internship Program, or iPrep). Continue to call
until you reach your. Internship provider, -
3. At the interview, discuss with your internship provider the activities available to you, internship
responsibilities, and the days and hours you are required to attend.
4. Bring this form and a resume with you to the interview. Respective individuals must sign below for the
placement to be complete. Before you leave the interview, if hired, set a day to begin the internship no
later than the first week of school, August 18-22, 2014.
5. The student should keep a copy for their records and send by fax or email to (305) 995-2888 or
lnternshipsadadeschools.net.
STUDENT INFORMATION
Student Name:
ID #:
School:
Parent's! Guardian's Name:
Student's E-mail:
Number of Credits:
Course Number:
PROPOSED INTERNSHIP PROVIDER INFORMATION
Internship Provider's Name:
Title:
Mail Address:
Phone:
Fax:
E-mail:
Internship Provider's Signature: Date:
Student's Signature: Date:
Parent's Signature: Date:
8
Miami -Dade County Public Schools
Office of Community Engagement/Internship Program
Required Student Procedures
1. Internship commitment is for the entire school year.
2. Transportation difficulties cannot be an excuse to exit the program, Confirm
transportation prior to committing to the program.
3. Once you are accepted into the program you will receive a Student Placement Form
(SPDF). Use information on this form to contact your internship provider and set up an
interview. The SPDF must be returned to the office immediately after interview with
internship provider.
4. Any changes in internship provider or student contact information must be
communicated to the Office of Community Engagement immediately and a new
Student placement form (SPDF) must be completed.
5. Students are required to keep a log that is signed by the internship provider every visit.
A copy is to be submitted by fax or email to the Office of Community Engagement by
the student two weeks prior to completion of grading period.
6. Student cannot intern with a family member or in a home -based business.
7. A grade sheet must be submitted by the internship provider directly to the Office of
Community Engagement two weeks before the end of the grading period,
8. For additional information, please review the handbook at
htfp://community.dadeschools.net/linternship/HE overview.asp.
Print Student Name ID#
I have read and understand the Required Student Procedures. Non-compliance with
the procedures may result in the student's failure of a grading period and/or removal
from the program.
Student's Signature
Date
School Attending
Note: The receipt of this document is required to confirm placement in the program.
Office of Community Engagement
1450 NE 2nd Avenue, Room 202, Miami, Florida 33132
Internshios@dadeschools.net
Phone:305 995-1265
Fax: 305 995-2888
9
Intern Emergency Contact Information Sheet
Student Information:
Student's Name:
School:
Student's Phone:
Student's Email
Parent's Name:
Parent's Phone:
Parent's Email:
Other Contact: Phone:
Student Internship Schedule:
Monday: AM/PM to AM/PM
Tuesday: AM/PM to AM/PM
Wednesday: AM/PM to AM./PM
Thursday: AM/PM to AM/PM
Friday: AM/PM to AM/PM
Saturday: AM/PM to AM/PM
District Contact:
Program Coordinator: Ms. Caridad DePaola
Phone/Fax: 305-995-1265/305-995-2888
Emails: Internships@dadeschools.net
** As a courtesy to your internship provider please fill ou.t this page and give
them a copy.
10
Miami=Dade County Public Schools
Office of Community Engagement
Internship Program
1450 N.E. 2nd Avenue, Room 202
Miami, Florida 33132
Tel: 305 ,995.1265
Fax: 305--9 95.2888
Email: Internships@dadeschools.net
please Check One:
❑ Quarter 1 Due 10/10/2014
❑ Quarter 2 Due 01/05/2015
❑ Quarter 3 Due 03/06/2015
❑ Quarter 4 Due 05/22/2015
Internship Log Sheet 2014 -2015
Students Name: ID#
# of Credits (1 or 2):
Internship Provider's Name: Internship Site:
Instructions: Duplicate this form as needed. Each student is required to maintain a record of
his./her daily attendance and activities. Log sheet is to be faxed or emailed by the student to
the Office of Community Engagement each nine weeks by the due date.
Date Time In Time Out
Brief Description of Day's
Activity
Student's
Signature:
# of Hours
Internship Provider's
Signature:
Mentor's
Initials
School Name:
11