Placement Form
Placement Form
Placement Form
Student details
I have:
Contact details
Please refer to the Internship Study Overview information on MySCU - FSE Student Centre.
The start date CANNOT be before the date when this form is approved.
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My placement hours will vary due to my roster Yes ✔ No
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For the student - Notice of Placement Form
My placement is unpaid and I have read the SCU Student Insurance information
✔ Yes No
I am required to drive a motor vehicle during the performance of my internship duties ✔ Yes ✔ No
I understand that I must immediately notify the WIL Unit Assessor of any incidents or ✔ Yes ✔ No
accidents that occur while I am on placement.
My internship position requires me to have the following certificates or checks ☐ Drivers licence ☐ First Aid Certificate
☐ Working with Children Check/Blue Card
☐ Other
✔
By submitting this form electronically, I acknowledge that I have read and understood the requirements for enrolling into
Internship Study - ENVR3003, double weighted unit.
I also acknowledge and agree that:
I am still subject to all relevant University policies and procedures while on and associated with placements, including the
Code of Conduct, Student Rules Work Integrated Learning policy, Work Health and Safety policy and the Community Engaged
Learning Policy;
I cannot start my placement without providing a completed Notice of Placement Form to the University and the Placement Provider
signing an agreement to accept me for placement;
If my request is approved, I will receive confirmation and instructions on how to enrol via my SCU student email;
All host organisation intellectual property that I access while on placement remains the property of the original owner, but can be
referred to in my assessments for Internship Study ENVR3003;
I must comply with relevant privacy laws and not use or disclose the Host Organisation’s confidential information other than
for the purpose it was disclosed during the placement.
I must not include any of the Host Organisation’s confidential information in assessment items without their prior written consent.
If I am an employee of the Placement Provider, I am not covered by the University's insurances while on Placement.
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For the employer/host - Notice of Placement Form
Thank you for providing our student with an opportunity to undertake their internship with your organisation. The internship is a
very important component of the Faculty of Science and Engineerings, Bachelor of Science degree and aims to ensure that all
graduates who have undertaken an internship enter the workforce with valuable practical experience in accordance with the
Work Integrated Learning guidelines and the Community Engaged Learning policy
The Internship placement allows students to undertake an eight-week (280 hours) work placement for course credit. Most
students complete this full-time across eight weeks or part-time across 16-23 weeks during Tri Term 1 (approx. January – June)
or Tri Term 2 (approx. July – November).
While the student is undertaking their internship, they must also complete the required ‘work’ component and a series of
assessments. These assessments will be completed outside of their working hours.
Additionally, we request Supervisor’s to complete and return the Supervisor’s Evaluation form at the end of the placement. It
provides a record of the hours/weeks accrued and provides an evaluation of the student’s performance. This is an important
component of the student’s assessment and a compulsory requirement of the internship program.
Student duties
We encourage you to provide the student with a position description and/or list of responsibilities as soon as possible, and at
least two weeks prior to the placement start date. The student may undertake similar tasks throughout their placement or rotate
through various departments if possible and appropriate. We suggest that you discuss the current abilities and goals of the
student with them in order to determine a program or list of skills that they can and should acquire throughout their placement. If
the student currently works for you, we ask that you provide the student with different duties or responsibilities so that they have
the opportunity to learn new skills during the internship.
Intellectual property
• Copyright of the Student’s Assessment Items will be owned by the Student. This does not affect the ownership of any Host
Organisation IP which is referred to in those Assessment Items.
• The Host may request that the Student’s Assessment Items be examined under conditions of confidentiality. However, no
other restriction may be placed on the Student’s ability to lodge their Assessment Items for examination in accordance with
Southern Cross University’s policies.
Insurance
While undertaking an unpaid internship the student is covered by the University’s Public Liability and Personal Accident
insurance. Organisations who offer unpaid internships must have relevant public liability insurance. Further information is
available at Southern Cross University Insurances.
If the student is required to drive a vehicle during their placement, the Host Organisation must ensure that the vehicle and the
Host Organisation have the appropriate insurance to cover any liability arising from the use of the vehicle by the student (noting
that students may be under 25 years of age). It is the Host Organisation’s responsibility to check the currency of the student’s
drivers licence.
Internship approval
This form must be approved by Southern Cross University before the student commences the placement. Once the placement
has been approved, you and the student will receive confirmation via email.
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For the employer/host - Notice of Placement Form
Organisation/company name
Postal address
Phone number
I confirm that the Placement start and finish dates and outlined hours Yes No
on page 1 are correct.
Supervisor name
Supervisor email
Supervisor phone
Agreement
I agree to accept the above named student for an internship placement with my organisation.
I have read, understand and agree with the requirements listed in the Employer/host obligations and responsibilities section of this
form.
By submitting this form electronically, I acknowledge that I have read and understood all of the Host Organisation responsibilities and will
comply with these.
Signature Date
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