APPLICATION DEADLINE: January 31

Use this form to outline your proposed energy efficiency (E2)/pollution prevention (P2) intern project. The Pollution Prevention Institute can provide application assistance if needed. For assistance, please call the Intern Coordinator at 800-578-8898.

Your company's responsibilities toward this program include the following:

1. Reviewing the attached Terms and Conditions
2. Providing computer and work area for the intern to perform his or her job duties
3. Naming a company representative to participate in the student selection process
4. Providing safety equipment and training as appropriate for the intern

Note: Students will be required to provide their own health insurance for program participation.

COMPANY INFORMATION

PROJECT DESCRIPTION

1. Describe the pollution prevention needs or projects you would like to have an E2/P2 or H2E intern assist with at your company. List at least three project objectives. (Contact 800-578-8898 if you have questions.)
 

Evaluation criteria:

• Relates to continuous improvement efforts to address environmental opportunities
• Relates to energy efficiency, P2, and source reduction
• Well-developed and measurable objectives

2. Clearly describe the desired results of the project and list expected project outcomes. If this is a subproject of a larger project, please discuss its relationship to the larger project.
 

Evaluation criteria:

• Potential economic benefit
• Risk reduction potential
• Pollution/waste reduction potential

3. Please describe the intern's expected role, responsibilities, and activities.
 

Evaluation criteria:

• Multidepartmental impacts
• Well-defined role and responsibilities

4. The company supervisor's role is critical to the success of the project. Please provide the name and contact information of the individual within the company that will be assigned to supervise the intern. Then describe his or her role and responsibilities as they relate to the project.

• Designated environmental staff
• Previous company experience with interns
• Well-defined supervisor's role and responsibilities
• Continuous supervision available

CONTINGENCY PLANS

5. Describe alternative strategies for supplemental projects the intern may be assigned if unforeseen events result in delay or suspension of this project, or during periods of shutdown.
 

Evaluation criteria:

• List of secondary projects planned
• Description of project relationship to pollution prevention and/or energy efficiency
• Well-developed project activities, with specific and measurable objectives

INTERN BACKGROUND

6. Please indicate preferred major category.

• Engineering
• Environmental science/studies
• Physical science
• Economics/business
• Specific discipline(s) or skills and abilities, if desired:

7. As a host company, you will provide payment for the intern in the amount of $12/hour, plus fringe. Do you agree to this financial obligation?

• Yes
• No

8. Can you assist the E2/P2 intern in locating short-term housing opportunities?

• Yes
• No

Upon successful completion of the project, short case studies will be developed for your company's project and posted to the PPI Web site. Would your company be willing to share project outcomes with other Kansas businesses through any of the following means? (Check all that apply. Confidential information is not disclosed; however, case study development is mandatory to our project.)

• Departmental newsletter
• Facility tours for related businesses
• Articles in association newsletter
• Presentations to association meetings, workshops, or conferences

Upon the host company’s acceptance of an intern and the intern’s acceptance of the position offered, the host company accepts the following terms and conditions of the program.

1. SCOPE OF WORK. The host company agrees to use its best efforts to implement the project defined in the application submitted for this program. A PPI technical specialist will be available to work with the host company and the student intern to ensure project success. The student intern shall perform services for the host company and PPI as defined by the host company’s application and other tasks as identified by the host company and/or the PPI coordinator during the period of the internship. Any changes in the project focus will require written acknowledgement by both PPI and the host company.
2. DURATION. Project objectives of the internship will be completed between May and August 2012. Any changes to the duration of the internship project will require written acknowledgement of both PPI and the host company.
3. REPORTING. PPI and the host company will provide the other with reasonable technical reports and access to technical personnel associated with the conduct of the P2 project as may be reasonably requested from time to time.
4. STUDENT PROGRESS REPORTS. The student intern will submit weekly progress reports to the PPI coordinator, also submitting a copy to the host company’s supervisor. A final report by the student intern will be rendered upon completion of the internship period. During the term of the internship, the PPI coordinator will consult and/or meet with the student intern and/or the host company’s supervisor to monitor progress and results, as well as on going plans of the internship.
5. STUDENT FINAL PRESENTATION. The student will make a final presentation to representatives of the PPI at the conclusion of the internship period. The presentation will describe progress and project results in relation to the student’s internship activity and scope of work as defined by the host company’s application and other tasks assigned by the host company or PPI. Representatives for the host company are invited and encouraged to attend.
   The presentation day and time shall be arranged with the PPI coordinator and shall take place no later than September 14, 2012, in order for PPI to meet its reporting obligations to the U.S. Environmental Protection Agency and the Kansas Department of Health and Environment.
   The student intern shall prepare and submit a draft report no later than July 27, 2012, and final report by August 3, 2012. Modification of report deadline date shall be at the discretion of and with the approval of the PPI coordinator.
6. STUDENT INTERN SUBSISTENCE. The student intern’s subsistence needs (lodging, meals, local travel, and other incidental living expenses) are the responsibility of the student intern.
7. STUDENT INTERN WORK SCHEDULE. The student intern shall submit time-sheets to the host company’s coordinator as required and follow work hours as prescribed by the host company. The student intern will notify the supervisor at the host company in advance of any necessary deviation from the work-schedule.
8. STUDENT INTERN CONDUCT. The student intern shall abide by all the rules of conduct for the host company and the University. The host company may define appropriate dress for the student intern.
   If through any cause the student intern shall fail to maintain a good standing with the host company, the student intern may be removed from the Internship Program after the host company and/or the University has documented evidence to the student that he/she is not performing to an adequate level of competency for a trainee and/or the professional conduct of the individual is short of the reasonable and understood standards of the host company and/or the University. Wherever possible, the student intern will be given the opportunity correct his/her work prior to removal from the Internship Program.
9. PROJECT CONTACTS.
   • K-State PPI intern program coordinator: David Carter, 785-532-4998, dcarter@ksu.edu
   • K-State PPI director: Nancy Larson, 316-660-0104, nlarson@ksu.edu

I have read, and agree to, the above terms and conditions.