For the student - Notice of Placement Form

Work Integrated Learning

Faculty of Science and Engineering
Notice of Placement Form

Student details

Student Id First Name Surname SCU Email

23816109 Nina Zanotto n.zanotto.10@student.scu.edu.au
Students must complete all the information below for each placement undertaken and submit to wil-science@scu.edu.au.
Please note: Diving activities are not permitted during an Internship Placement.

I have:

* completed the pre-requisite unit ERTH2004 (or equivalent) ✔ Yes ✔ No

* completed at least 16 units (192 credit points) ✔ Yes ✔ No

Contact details

Your phone number

0499 910 008
Residential address 38 Ocean Street, Rosebud
Town, state and postcode Rosebud, Victoria, 3939
Country
Australia
Postal address (if different from above)

Name of your emergency contact Nella Dugec

Phone number for your emergency contact
0408 751 279
Placement details and conditions

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.

Hours per week 20 Start date 2/1/24 Completion date 26/4/24

Monday Tuesday Wednesday Thursday Friday Weekends

4 4 4 4 4
My placement hours will vary due to my roster Yes ✔ No

I am undertaking this placement in the following capacity: Paid

✔ Unpaid
Combination
Bursary

Page 1 of 4
 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.

Please feel free to contact us on wil-science@scu.edu.au with any questions or concerns.

Student Signature Date NinaZanotto 7/11/23

Page 2 of 4
 For the employer/host - Notice of Placement Form

Host organisation details and placement description

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.

Employer/host obligations and responsibilities

General obligations and requirements are:
• Provide the student with a supervised learning opportunity for the duration of the 280 hour placement.
• Complete and lodge this form at least two weeks before the student starts.
• Provide details of the student’s workplace performance during a phone call with the Unit Assessor.
• Complete and submit the Supervisor’s Evaluation Form which will be sent to you.
• If the student is paid then ensure payment is in accordance with the relevant award or enterprise agreement.
• If the position is unpaid then provide a copy of the public liability certificate of currency.
• If the student is already employed by you then ensure that during the period of the internship the student undertakes
different duties for additional learning.
• Provide a safe work environment and ensure that all relevant Work Health and Safety regulations are met.
• Provide an induction which covers work conditions and expectations, personal conduct standards, emergency
procedures, privacy and security procedures and all relevant policies.
• Report any workplace incident or accident involving the student to the WIL Unit Assessor on wil-science@scu.edu.au

Contact with Work Integrated Learning Staff

The student’s WIL Unit Assessor will endeavour to contact you via phone or email a number of times throughout the
placement period in order to discuss the progress of the student.
Please feel free to contact us on wil-science@scu.edu.au with any questions or concerns.

Page 3 of 4
 For the employer/host - Notice of Placement Form

Organisation/company name

Postal address

Phone number

Australian Business Number (ABN)

Intern position title

Placement duties - you can attach a position description

I confirm that the Placement start and finish dates and outlined hours Yes No
on page 1 are correct.

This student currently works for this organisation in the same

Yes No
capacity as listed above

If yes, what was the commencement date?

We hold public liability insurance and a copy of our Certificate of Yes No

Currency is attached

The student is required to drive a motor vehicle during the Yes No

performance of their internship duties
If yes to the above, we ensure the currency of the student’s driver’s
Yes No
licence will be checked and the relevant insurances will be provided

We will monitor the student's attendance and notify the university

Yes No
should any issues with attendance or performance arise

Supervisor name

Supervisor position title

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.

Please feel free to contact us on wil-science@scu.edu.au with any questions or concerns.

Signature Date

Page 4 of 4