1 625 Lower Road • Souderton, Pennsylvania 18964 • Telephone: 215.723.2808 • Fax: 215.723.6352 • http://sahs.soudertonsd.org

Souderton Area S c h o o l D i s t r i c t

P r o g r a m / C a m p I n t e r n s h i p C o n t r a c t

Student Information

Student’s Name:

Street Address:

City: State: Zip:

Home Phone:

Cell Phone:

Email Address:

Program Information

Program Name:

Location Address:

City: State: Zip:

Program Phone:

Program Website:

Contact Information

Program Contact Name:

Contact Phone:

Email Address:

Start Date End Date

General Criteria

1. The student will be mentored by experts from the career pathway. 2. The student will be introduced to the habits and skills of a successful employee. 3. The program will provide a minimum of 20 hours of simulations, first-hand learning experiences and/or field trips to introduce the student to the career pathway.

Souderton Area High School agrees to:

1. Provide necessary forms for the student to obtain credit for the experience. 2. Provide a review of programs prior to attendance to certify that Internship credit will be given for the

experience.

2

625 Lower Road • Souderton, Pennsylvania 18964 • Telephone: 215.723.2808 • Fax: 215.723.6352 • http://sahs.soudertonsd.org

P r o g r a m / C a m p I n t e r n s h i p C o n t r a c t

Student Intern agrees to:

1. Submit completed Contract for pre-approval to Mrs. Tarlo by Friday, May 24, 2013. 2. Perform the necessary tasks and follow instructions as given by the Program Coordinator. 3. Abide by the regulations, policies and rules of the program. 4. Provide transportation to and from the program site with parent permission. 5. Dress appropriately for the program internship experience. 6. Record daily journal entries on his/her activities to capture the experience for Final Reflection and Senior

Project Presentation. 7. Complete Final Reflection to obtain credit for Internship. Upload the Final Reflection into Bridges.

Program Mentor agrees to:

1. Verify the attendance and completion of a minimum of 20 hours. A certificate of completion is the preferred documentation.

The Parent or Guardian agrees to:

1. Provide transportation to and from the program site.

Signatures

Intern

Parent or Guardian

Program Mentor (Please sign after completion)