ࡱ> 241 bbjbj 4$b3333 ?,3PkkkkkFFF$ZCFFFFFCkkXrrrF kkrFrrUk4E3P"m n0u,rhFFrFFFFFCCrFFFFFFFFFFFFFFFF : MIDDLE TENNESSEE STATE UNIVERSITY Master of Arts in International Affairs (MAIA) Program Practicum Terms of Reference Agreement Registration Information to be completed by Practicum Student Student_______________________________________________________________________ Degree Option__________________________________________________________________ Year in Program__________________________________________________________ Practicum Supervisors Information------to be completed by Student Intern and Practicum Supervisor Name of Practicum Supervisor: ________________________________________ Title:__________________________________________________ Name of Organization: ___________________________________________________ Address: ___________________________________________________Tel:___________________ City: ____________________________State ________ZIP Code _______Country_______________ Practicum Start Date: _____________________________ End Date: _________________________ Title of Practicum position (if applicable)_________________________________________________ Academic Component Description to be completed by Student, MAIA Faculty Advisor and Practicum Supervisor Taking into consideration discussion with the student about his or her interests and objectives, please describe the practicum job responsibilities, tasks, and learning opportunities for the practicum student (where possible, please include anticipated activities, projects, meetings, training, etc.). Attach printed sheet if desired. D. Agreement and Signatures Practicum Supervisor: I have discussed this practicum with the student seeking the practicum and we have agreed upon the assigned work components appearance on this form. I agree to provide assistance including any necessary training and consultation to the student in order to enable him/her to advance toward his/her learning goals and objectives, provide an orientation concerning our organizational policies and procedures, meet with the student regularly, and provide a written evaluation of the student to the faculty adviser. _______________________________________________ Name of Supervisor (Please Print) _______________________________________________ ___________________________ Signature of Supervisor Date Practicum Faculty Advisor: I have discussed the academic/experiential component of this practicum with the student and I accept this as a work plan for the Master of Arts in international Affairs Program. I further agree to meet periodically with the student to discuss the practicum experience and will conduct an assessment/evaluation of the practicum experience. _______________________________________________ _________________________ Faculty Advisors Signature Date Practicum Student: I concur with and accept the academic and work assignments indicated above. I will complete all work and academic assignments to the best of my ability. I accept the obligation of confidentiality in my work and will familiarize myself with and adhere to the organizations relevant policies/procedures and appropriate standards of conduct. _______________________________________________ ____________________________ Practicum Student Signature Date A signed copy of this form should be kept by the supervisor, the practicum adviser, and the student. 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