Internship Learning Agreement

We understand that the student has been called to this site to serve and to learn. This commitment to enhance the student’s undergraduate education is primarily for the purpose of acquiring the best training possible in preparation for effective service. North Central University and this organization are united in this enterprise of practical and theological education.

• We plan to work together in accordance with the design listed herein, with the understanding that it may be adjusted from time to time by mutual consent and with the approval of NCU’s Internship Director.
• The on-site supervisor and the intern will hold regularly scheduled weekly sessions for the purpose of evaluation, reflection, and sharing of concerns and prayer.
• We understand that should problems arise we will contact the Internship Director at NCU immediately.
• This organization, the intern, and North Central University may terminate this agreement through mutual consent.
• SIGNATURES

Student's Name: *

Student's Phone: *

On-site Supervisor: *

Title/Position: *

Church/Organization: *

Street Address: *

City: *

State: *

Zip: *

Phone: *

Email: *

Dates of Internship

Start Date: *

MonthJanFebMarAprMayJunJulAugSepOctNovDec

Day12345678910111213141516171819202122232425262728293031

Year1900190119021903190419051906190719081909191019111912191319141915191619171918191919201921192219231924192519261927192819291930193119321933193419351936193719381939194019411942194319441945194619471948194919501951195219531954195519561957195819591960196119621963196419651966196719681969197019711972197319741975197619771978197919801981198219831984198519861987198819891990199119921993199419951996199719981999200020012002200320042005200620072008200920102011201220132014201520162017201820192020202120222023202420252026202720282029203020312032203320342035203620372038203920402041204220432044204520462047204820492050

End Date: *

MonthJanFebMarAprMayJunJulAugSepOctNovDec

Day12345678910111213141516171819202122232425262728293031

Year1900190119021903190419051906190719081909191019111912191319141915191619171918191919201921192219231924192519261927192819291930193119321933193419351936193719381939194019411942194319441945194619471948194919501951195219531954195519561957195819591960196119621963196419651966196719681969197019711972197319741975197619771978197919801981198219831984198519861987198819891990199119921993199419951996199719981999200020012002200320042005200620072008200920102011201220132014201520162017201820192020202120222023202420252026202720282029203020312032203320342035203620372038203920402041204220432044204520462047204820492050

Learning Agreement Details

Beginning Date: *

MonthJanFebMarAprMayJunJulAugSepOctNovDec

Day12345678910111213141516171819202122232425262728293031

Year1900190119021903190419051906190719081909191019111912191319141915191619171918191919201921192219231924192519261927192819291930193119321933193419351936193719381939194019411942194319441945194619471948194919501951195219531954195519561957195819591960196119621963196419651966196719681969197019711972197319741975197619771978197919801981198219831984198519861987198819891990199119921993199419951996199719981999200020012002200320042005200620072008200920102011201220132014201520162017201820192020202120222023202420252026202720282029203020312032203320342035203620372038203920402041204220432044204520462047204820492050

Weekly Schedule: *

Please provide the weekly schedule if the following format: Monday - 3 hours, Tuesday - 0 hours, Wednessday - 5 hours

Estimated Weekly Contact Hours: *

Ending Date: *

MonthJanFebMarAprMayJunJulAugSepOctNovDec

Day12345678910111213141516171819202122232425262728293031

Year1900190119021903190419051906190719081909191019111912191319141915191619171918191919201921192219231924192519261927192819291930193119321933193419351936193719381939194019411942194319441945194619471948194919501951195219531954195519561957195819591960196119621963196419651966196719681969197019711972197319741975197619771978197919801981198219831984198519861987198819891990199119921993199419951996199719981999200020012002200320042005200620072008200920102011201220132014201520162017201820192020202120222023202420252026202720282029203020312032203320342035203620372038203920402041204220432044204520462047204820492050

Extra Events:

(camps, mission trips, after hours events, etc.) Please provide the weekly schedule if the following format: Event Name - 3 hours, Event Name - 6 hours

Total Esimated Contact Hours: *

Regularly Scheduled Weekly Meeting with Supervisor:

Reading Assignments:

(In addition to those outlined in the course syllabus)

Number of Pages Assigned:

Work Assignments:

(Submit additional pages if necessary)

Submission of this form indicates acknowledgement of and agreement to the policies, procedures, and requirements of NCU’s Internship program.

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