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  • STUDENT APPLICATION

    Welcome to your Practicum/Work-Based Learning Experience! Please take time to complete the application below.

  • 288 Pre-requisite Courses

    One of the two courses below must be taken concurrently or prior to enrollment in any 288 course. Check with your Program Faculty.

  • Need accommodations?

    Contact LCC's Disability and Access Services: call 360.442.2341 or email mmorgan@lowercolumbia.edu

  • Work-Site Information

    Indicate the site where you intend to complete your work-based training, if known.

  • Volunteer/Internship Agreement

    This agreement establishes the terms and conditions under which the student/intern named above will participate in a practicum or work-based training experience through Lower Columbia College for academic credit. 

    The goal is to provide the student/intern with experiential workplace learning that fosters professional readiness and reinforces Learning Agreement Objectives aligned with the student's academic program.

  • Eligibility Confirmation

    Answer the questions below

  • Student Roles and Responsibilities

     

    Confirm that you understand and agree with the practicum conditions below. 

  • I agree to track and submit internship/practicum/volunteer hours on the timesheet provided through my Canvas course.*
  • I agree to abide by all rules and safety policies of the Worksite and the College. Failure to do so may result in removal from the course/site.*
  • I acknowledge that LCC recommends the purchase of personal health and accident insurance to provide coverage during the work-based learning experience. I understand that obtaining such insurance is voluntary and is my responsibility.*
  • I agree to maintain confidentiality regarding any proprietary or sensitive information acquired during the internship, including but not limited to: students, families, business operations, financial information, customer and supplier data, trade secrets, designs, inventions, processes, formulas, technology, marketing plans, and any other information that reasonably should be understood to be confidential given the nature of the information and the circumstances of disclosure.*
  • I agree to notify both LCC faculty and the Worksite supervisor/trainer of any scheduling conflicts or issues impacting participation and make arrangements to make up the time.*
  • I agree to complete and submit all academic and reflective components required for credit.*

  • LCC Code of Ethics

  • I have read and understand the LCC Employee Code of Ethics (linked above)*

  • Insurance and Workplace Injury Procedure

    Any workplace injury must be reported immediately to the Worksite supervisor and online: https://lowercolumbia.edu/students/make-a-report/ (Save this link) - Use the “Near Miss, Injury, or Hazardous Condition” report.

  • I understand the procedure for workplace near-miss/injury/hazard reporting, and can locate the link for reporting.*

  • You marked "no" to an Eligibility Statement

    To be eligible for participation in LCC Work-Based Learning or practicum, applicants must satisfy the eligibility criteria identified above, including affirming their intent to comply with all applicable program requirements, policies, procedures, and directions provided by authorized representatives of the College and any participating worksite. An applicant who does not meet the stated eligibility criteria or does not affirm their willingness to comply with these requirements is not eligible to participate in the Work-based Learning Program, except as otherwise required by applicable law or College policy.

  • Insurance and Non-Employment Relationship

    In accordance with RCW 4.92.130, the College will provide Labor and Industries (L&I) industrial insurance coverage for eligible Students/Interns during approved volunteer/internship hours. This coverage is NOT available to worksite employees.

    Hours may be accrued in either a paid or unpaid (volunteer) capacity.

    Participation in this program is a learning opportunity and does not constitute an offer or guarantee of future employment by the Worksite or the College.

    Those enrolled in practicum field work experience may be denied unemployment for the duration of work-based training.

  • Authorization for Release of Information
    I authorize Lower Columbia College ("College") and its authorized agents, including any consumer reporting agency or background screening provider retained by the College, to obtain and verify information necessary to determine my eligibility for an internship, practicum, clinical placement, volunteer assignment, or other College-related placement when a background check is required by law, regulation, contractual obligation, accreditation standards, College policy, or the requirements of a placement site.

    I authorize any educational institution, employer, licensing or certification agency, governmental agency, law enforcement agency, motor vehicle licensing authority (when driving is a requirement of the placement), military branch, professional reference, or other custodian of records to release information relevant to the background check upon request.

    The information that may be obtained includes, as applicable:

    • Identity verification
    • Education, degrees, certifications, licenses, and credentials
    • Relevant employment history, including dates of employment, positions held, and information related to job performance or eligibility for rehire
    • Criminal conviction history and other criminal history information as permitted by applicable federal and Washington law
    • Motor vehicle records when driving is an essential function or requirement of the placement
    • Any other information reasonably necessary to evaluate my eligibility for the placement and permitted by law.

    I understand that the information obtained under this authorization will be used solely for purposes related to determining my eligibility for the applicable internship, practicum, clinical placement, volunteer assignment, or other authorized College activity and will be maintained and disclosed only as permitted by law.

    I certify that the information I have provided to the College is true and complete to the best of my knowledge.

    This authorization is valid for the duration of my application for, participation in, or continued eligibility for the applicable internship, practicum, clinical placement, volunteer assignment, or other College program requiring a background check, unless revoked in writing where permitted by law. A photocopy or electronic copy of this authorization shall be as valid as the original.

  • Hazards and Acknowledgment of Risks

    I understand that participation in this course/activity involves inherent risks of injury or illness, which may vary depending on the Work site, type of activity, the instructor or program representative, and my own physical condition and conduct. I voluntarily assume all risks of loss, damage, illness, or injury — including those arising during travel or from the use of any equipment or facilities — while participating in this course/activity.

    I understand that certain safety precautions may be recommended, and I agree to follow all rules, policies, and instructions provided by the instructor, program representative, department, or sponsoring organization. However, I recognize that these precautions may not eliminate every risk, and I understand the importance of staying aware, advocating for my well-being, and taking responsibility for my personal safety throughout this experience.

    I understand that I am responsible for my own medical and accident insurance. Lower Columbia College does not provide direct medical or accident coverage. If I am injured while participating in a work-based learning experience as a volunteer/intern (non-employee), I may be covered by the College’s workers’ compensation (L&I Insurance). If employed by the work-site, I understand that I am ineligible for L&I coverage through the college.

    If any part of this Acknowledgment of Risk is found to be invalid or unenforceable, the remaining sections shall remain in effect.

    I have carefully read this Acknowledgment of Risk, fully understand its contents, and recognize that it is a binding agreement between me and Lower Columbia College.

     

  • Next Steps

    Lower Columbia College will contact your desired Work-based Training Site for approval and an Affiliation Agreement.

    Once approved, LCC Faculty will collaborate with you (the student/intern) and the work site supervisor to design a Learning Agreement relevant to your program.

    A SUMMARY OF YOUR RIGHTS UNDER THE WASHINGTON FAIR CREDIT REPORTING ACT
    The Washington Fair Credit Reporting Act, located at Chapter 19.182 RCW, substantially parallels the federal Fair Credit Reporting Act and the rights and remedies set forth in the Federal Trade Commission’s Summary of Rights, except that, effective July 22, 2007, the Washington State law imposes greater limitations on the reasons for which an employer may obtain a consumer report. Beginning July 22, 2007, an employer may not obtain a consumer report that indicates the consumer’s creditworthiness, credit standing, or credit capacity, unless (1) the information is substantially job-related and the employer’s reasons for using the information are disclosed in writing, or (2) the information is required by law.

    COMPLAINTS
    Any complaints by consumers may be directed to:

    THE ATTORNEY GENERAL’S OFFICE IN WASHINGTON
    CONSUMER PROTECTION DIVISION

    For Information Call: The Consumer Resource Center
    Statewide Toll-Free Number: 800-551-4636
    Statewide Toll-Free TDD: 800-276-9883

    Complaints May Be Made Via U.S. Mail or E-Mail
    Complaints: http://ww.atg.wa.gov/FileAComplaint.aspx
    (Include your U.S. Mail address with any complaint.)
    Website & Forms: http:///www.atg.wa.gov/

    Equal Opportunity Statement:
    Lower Columbia College provides equal opportunity in education and employment and does not discriminate on the basis of race, color, national origin, citizenship or immigration status, age, perceived or actual physical or mental disability, pregnancy, genetic information, sex, sexual orientation, gender identity, marital status, creed, religion, honorably discharged veteran or military status, or use of a trained guide dog or service animal as required by Title VI of the Civil Rights Act of 1964, Title VII of the Civil Rights Act of 1964, Title IX of the Educational Amendments of 1972, Sections 504 and 508 of the Rehabilitation Act of 1973, the Americans with Disabilities Act and ADA Amendment Act, the Age Discrimination Act of 1975, the Violence Against Women Reauthorization Act and Washington State's Law Against Discrimination, Chapter 49.60 RCW and their implementing regulations. All inquiries regarding compliance with Title IX, access, equal opportunity, and/or grievance procedures should be directed to the Vice President of Foundation, HR & Legal Affairs, 1600 Maple Street, PO Box 3010, Longview, WA 98632, title9@lowercolumbia.edu, Phone number, (360) 442-2120, Phone number/TTY (800) 833-6388.

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