„Bionanomaterials - BioNaM: nowy kierunek interdyscyplinarnych studiów doktoranckich oraz program
staży dla studentów na I, II i III stopniu kształcenia”
CERTIFIED TRANSLATION FROM POLISH
Appendix No 4
to the Regulations of Internships for undergraduate and postgraduate Master programme students
of full-time mode in the framework of the Project ”Bionanomaterials - BioNaM: a new
interdisciplinary field of Postgraduate PhD studies and an internship programme for undergraduate,
postgraduate Master programme and PhD students”.
PRELIMINARY DECLARATION
With regard to the project to the Project ””Bionanomaterials - BioNaM: a new interdisciplinary field
of Postgraduate PhD studies and a programme of internship for undergraduate and postgraduate
Master programme students” and in compliance with the agreement No UDA-POKL.04.01.01-00017/13, order No W-3/…………., financed with the financial resources obtained from the National
Centre for Research and Development (85 % of financial resources from the European Social Fund
and 15% from the State Budget) in the framework of Priority IV of the Human Capital Operational
Programme 2007-2013
The Company ……………………………………………………………………………………………………………………………
with the registered seat at:…………………………………………………………………………………………..…………..
hereinafter referred to as „the Company” , represented by :
……………………………………………………………………………………………………………………………………………………….
Full name, position
hereby declares and says, that
§1
We shall undertake to organize the internship for
…………………….…………………………………………………………………………………………………………………………,
Full name
Student’s Personal Number PESEL
the student of the Faculty of Chemistry, Wrocław University of Technology, domiciled at
……………………………………………………………………………………………………………………………………………………………
address
2. The internship shall last …………………………. months, from …………………..
to ……………………………………..1, with 160 hours of work per months.
3. The Company appoints : ………………………………………………………………….
Full name
……………………………………………………………………………………………………………………………………………………….
Position
tel.: ……………………………………., e-mail: ……………………………………………………………………………………………
1
Put down the first calendar day of the month when the internship commences and the last calendar day when
the internship is terminated.
Projekt współfinansowa ny ze środków Unii Europejskiej w ramach Europejskiego Funduszu Społecznego
„Bionanomaterials - BioNaM: nowy kierunek interdyscyplinarnych studiów doktoranckich oraz program
staży dla studentów na I, II i III stopniu kształcenia”
to the supervisor of the intern.
§2
The Company undertakes to :
a) prepare the internship plan in compliance with the appendix 1;
b) assign tasks corresponding to the Student’s qualifications ;
c) check the attendance list of the Intern;
d) approve the Student’s weekly internship reports by the Supervisor;
e) approve and sign the final internship report by a person authorised to represent the
Company ( e.g. the manager, president) .
§3
After Wrocław University of Technology qualifies the Student for the internship in the Company,
Wrocław University of Technology shall enter into the internship agreement with the Company.
§4
The preliminary declaration is made only for the purposes of the recruitment of a student by
Wrocław University of Technology for the internship and does not create any financial or
organizational liabilities for the company if the Student is not qualified for the internship.
§5
The provisions of the Labour Code are not applicable to this preliminary declaration.
The present preliminary declaration is made in two identical copies, one for each Party.
……………………………………………………………….…………….
Signature of a person authorised by the Company
………………………………………………………………………………..
Official Stamp of the Company
Projekt współfinansowa ny ze środków Unii Europejskiej w ramach Europejskiego Funduszu Społecznego
„Bionanomaterials - BioNaM: nowy kierunek interdyscyplinarnych studiów doktoranckich oraz program
staży dla studentów na I, II i III stopniu kształcenia”
CERTIFIED TRANSLATION FROM POLISH
Appendix No 1 to Preliminary Declaration
INTERNSHIP PROGRAMME
Project POKL.04.01.01-00-017/13
Name: Bionanomaterials - BioNaM: a new interdisciplinary field of Postgraduate PhD studies and an
internship programme for undergraduate, postgraduate Master programme and PhD students
Student’s name
Company name and address
………………………………………..
………………………………………………………
………………………………………………………
Type of studies
Semestr
…………………………
……………………….
Department/unit/place of internship
……………………………………………………………
Description of the performed activities
No of
hours
(Please write legibly )
1.
Occupational health and safety (OHS) training
2.
3.
Scope of the activities of the company/ institution
4.
Organizational structure of the company unit
5.
Individual programme (please fill in )
6.
7.
8.
9.
Individual programme (please fill in )
2-8*
Procedures controlling the efficiency of the company unit (ISO standards and others )
Individual programme (please fill in )
Individual programme (please fill in )
Preparation of the report of the performer tasks
TOTAL**:
* - depending on the number and type of potential hazards in the company/ institution. The Internship Supervisor and the OHS
instructor decide about the length of the training
Date
Date
Supervisor’s signature
Company Stamp
Project Coordinator’s or Manager’s signature and stamp
** The number of hours should be 480 in case of 3 months’ internship.
Projekt współfinansowa ny ze środków Unii Europejskiej w ramach Europejskiego Funduszu Społecznego