Academic Internship/Co-op Verification Form
Site Supervisors: Please utilize this form to report student specific experiential opportunity information
so that they may complete paperwork to be registered for their academic experience.
 Questions? Contact Tina Cooper, Internship Coordinator
at or (315) 312-3693.
This form MUST be completed by the direct supervisor of the student. *
Company/Site Information
This opportunity is: *
Are you a SUNY Oswego Alum? *
**Direct contact information is required in the case that more information from the site supervisor is needed. The individual completing this form should be the direct mentor and evaluator of the student.**
Position Information
Select Opportunity Type: *
Host Site Type: *
Percent of experience hours that will be On-Site: *
NOTICE: In light of the uncertainties caused by the COVID-19 precautions, we are requesting that all sites who are planning to host interns for Summer 2020 and Fall 2020 consider developing remote hour options for students to complete their internship in the case that a student is unable to start or continue on-site hours. Please consider any mentorship, technology, and communications requirements that the student may need to ensure the continued success of the student(s).
Based on the above notice: In the event a student is no longer able to attend site in person, does your organization have the ability to offer the experience (or remainder of experience) virtually? *
As a representative of an internship or co-op host organization, I affirm that my site is currently, and will continue to be, in compliance with all applicable laws, regulations, and public directives, including, but not limited to, those issued in times of an emergency, regarding the health and safety of employees, the public, and students participating in experiential learning opportunities. This includes current compliance in relation to COVID-19 spread prevention with social distancing, PPE, and applicable safety protocols. My organization understands that, in the case a SUNY Oswego student is on site and is not provided with an adequate work space meeting such requirements, any student may be removed from the site by the institution and/or the institution may retract proof of educational benefit towards the experience. *
Please Note: Any unpaid virtual or hybrid internships must demonstrate structured and consistent mentorship/supervision for the benefit of the student in order to be approved.
Please select the option that applies to your situation: *
Student Specific Information
Site verification forms may not be completed after the completion of an experience.
FALL 2020 submission is now past deadline.
During which upcoming term will the student(s) complete this experience? *
Is this a paid experience? *
Type of Pay: *
Please note: If you are looking to supervise more than 3 students, please contact Tina Cooper at (315) 312-3693 to discuss the internship/co-op program to have this approved.
Student 1 
Student 2
Student 3
Student 4

As an organization offering an unpaid opportunity, please review the requirements set forth by the U.S. and New York State Departments of Labor:

Internship Programs Under the Fair Labor Standards Act (U.S.)

Wage Requirements for Interns in For-Profit Businesses (NYS)

Wage Requirements for Interns in Not-For-Profit Businesses (NYS)

By checking below, you agree that your organization will abide by these requirements. *
Intern/Co-op Description: what tasks will the student(s) perform? (Please be detailed, N/A is not an acceptable entry)
By submitting this position description form you are affirming that you have read and agree to the site's responsibilities outlined on the EXCEL: Experiential Courses and Engaged Learning website. In the case that the SUNY Oswego student(s) selected for this opportunity submits photo testimonial of their experience, submission of this form affirms permission from the site to utilize these materials.
Thank you for your support of our experiential learning program!
EXCEL:  Experiential Courses and Engaged Learning
State University of New York College at Oswego
145 Marano Campus Center
Oswego, NY 13126
Phone: (315) 312-2151
Fax: (315) 312-5406