Umbra Institute Form for Interns

Dear Intern,
Please take 15-20 minutes to fill in all of the necessary information to register at the Umbra Institute for your upcoming internship. Before starting, make sure you have your passport information.

Completing this form and signing all participation documents and waivers is MANDATORY for participation in any program hosted by the Umbra Institute. This section contains the following forms for your review and signature:

Personal Info Form
Health Info Form
Internship Agreement
Waiver of Liability, Hold Harmless and Release
Student Code of Conduct
Housing Form
Student Housing Agreement
GDPR European Privacy Law Agreement

If you have questions or problems reviewing and signing these forms, please send an email to [email protected]. All form and documents will be viewable and retrievable for future reference on the Online Accepted Student Handbook and via the Umbra App.

Thank you and we look forward to welcoming you to Italy soon!
The Umbra Staff

Note: The Umbra Institute in Perugia is a subsidiary of the International Studies Institute LLC, the International Studies Institute in Florence (ISI Florence) and part of ISI Abroad international educational programs. All terms and conditions apply.

Personal Details

Name*

First Last

Preferred First Name or Nickname

First

Phone Number*

Do you plan to use the number above with an international plan?*

Yes

No

I'm not sure yet

Umbra provides support upon arrival to help you rent a local phone if you prefer to use an Italian cellphone or SIM card. Should you initially choose to have an international plan but change your mind, you can simply supply Umbra staff with your Italian phone number.

Important: Note that whether you choose an international plan or an Italian number, you are required to have a phone that can send and receive Italian phone calls for the duration of your time abroad. You must keep this phone charged and active. It should not go on airplane mode unless you are in an airplane.

Date of Birth*

Sex*

Male

Female

(optional) If you have a pronoun preference you would like to share, please select one from below.

He/Him/His

She/Her/Hers

They/Their/Theirs

Country of Citizenship*

Country

What is the status of your passport?*

I have one and it will be valid for at least 3 months after the program ends.

I have applied for one.

I still need to make an appointment.

Important:
It is important that this upload be a scan of your signed passport in a jpg, png, or pdf format. This scan should not
- Be blurry
- Have shadows that cover up detailed information
- Be missing the signature page
- Feature fingers

Please note that if you do not have access to a formal scanner, you may want to consider using the scan feature of the Google Drive App on your phone or another scanning App.

Not having a passport does not make you ineligible for acceptance to the Umbra Institute. However, we will get in touch with you in the near future to confirm that you are on track to have your passport in time for your semester abroad.

Please upload a copy of the primary page of your passport.

Accepted file types: jpg, jpeg, png, gif, heic, Max. file size: 7 MB.

The file upload can be either a jpg, png, or pdf file.

School Email*

Preferred Email*

Enter Email Confirm Email

Please indicate the email address that you check most often. If it is the same as your school email, please retype it here.
This is important for emergency communication. Your email will be used only for school-related matters.

Emergency Contact/Parent/Guardian 1

It is not required that your emergency contact be a parent or guardian. We simply ask that contact information be provided for someone whom you would like us to reach out to on your behalf, in case of an emergency.

Type of relationship*

Name*

First Last

Email*

Phone*

Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Emergency Contact/Parent/Guardian 2

It is not required that your emergency contact be a parent or guardian. We simply ask that contact information be provided for someone whom you would like us to reach out to on your behalf, in case of an emergency.

Type of relationship

Name

First Last

Email

Phone

Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

It is important that you inform us of any and all medical problems (past or current), including mental health conditions, which might affect you during your time abroad. This information could prove vital in assisting you with your health in the event of an emergency. Umbra also uses your health information to accommodate dietary restrictions you may have, when planning events. Please be as specific and accurate as possible. All information provided will be kept in strict confidentiality. I hereby certify that the information below is true and accurate.

Medical Information*

I have read and understood the Health Information text above

Date(mm/dd/yyyy)*

Do you have any chronic health conditions? Please explain.*

Do you have any allergies? Please describe them in detail.*

Have you ever suffered from asthma or any other respiratory ailment? Please explain.*

Are you currently taking any prescription or over the counter medications? Please explain what they are and what they are for.*

Have you had any major injuries, diseases, or ailments in the past five years? Please explain.*

Have you ever been treated or are you currently being treated for any psychological or emotional distress? Please explain.*

Do you have any dietary restrictions the Institute should be aware of? Please explain.*

It is important that you leave a note regarding dietary restrictions (ex. celiac, vegan, vegetarian, or restrictions due to a religious background). You do not need to tell us the reason for these restrictions but you are likely to be fed either through an extracurricular or co-curricular activity while abroad and we want to be sure that there is something delicious you can eat at each such activity.

Do you have a diagnosed learning disability? Do you have any other relevant disabilities that require specific accommodations? Please explain.*

Do you receive any accommodation from your home university for any physical or learning disabilities? Please explain.*

NOTE: If you receive accommodations of this nature on your home campus, you are also eligible for them while abroad. If you indicate a need above, our team will contact you to receive appropriate documentation so as to facilitate arrangements.

Is there any additional information that would be helpful for the program to be aware of during your study abroad experience?

List any health conditions - surgeries, hospitalizations, significant injuries, chronic conditions, physical illness, mental health concern, etc. that may require special consideration or attention while in Perugia, or that may impact treatment should you seek medical assistance while abroad, physically or mentally.

INTERNSHIP AGREEMENT

Please read the following internship policies and guidelines carefully. The Intern specifically agrees to and understands the following:

All Interns will be registered into the Umbra Institute course entitled INT499 INTERNSHIP, as either a for-credit internship where a transcript with a letter grade will be issued, or as a non-credit internship where a transcript with a Pass/Fail indication will be issued.
The work performed and education received by the Intern from the internship is for the express benefit of the Intern.
The Intern does not replace or displace any employee of the Umbra Institute or host company.
The Intern will receive direct and close supervision by an appropriate supervisor.
The Umbra Institute and/or host company do not derive an immediate advantage from the activities performed by the Intern.
The Intern is not entitled to wages or any compensation or benefits for the time spent in the internship.
The Umbra Institute and/or host entity are not liable for injury sustained or health conditions that may arise for the unpaid intern during the course of the internship.

The Intern also specifically agrees to and acknowledges the following:

The internship is educational in nature and there is no guarantee or expectation that the internship will result in employment.
Interns may be required to perform physical tasks such as lifting, gardening, planting, cleaning and other tasks specifically related to my internship.
Interns will maintain a regular internship/work schedule determined by the Intern and their supervisor.
Interns will demonstrate honesty, punctuality, courtesy, cooperative attitude, proper health and grooming habits, appropriate dress and a willingness to learn.
If any Intern gives the supervisor or sponsoring faculty member reasonable cause to believe that continued participation in the practicum poses a danger to the health or safety of persons or property, or impedes, disrupts, or obstructs the institute’s operations in any way, Interns will be immediately dismissed and will forfeit any course credit hours earned if they had not been dismissed from the practicum, and, if dismissed after the refund deadline, will also forfeit any associated tuition costs.
If Interns withdraw from the internship program after commencing work, they must do so in a manner that is professionally responsible and considerate of the operations of the host entity. Interns also understand that they will forfeit any credit hours had they not withdrawn from the program, and, if withdraw after the refund deadline, will also forfeit any fees associated with the internship.
Interns understand the Institute and/or host entity may at any time in its sole discretion, terminate the internship without notice for any reason it deems appropriate based on performance (excessive tardiness and/or absences), behavior, increased risk, or other factors that may require early termination of the internship.
Intern will furnish his/her supervisor with all necessary information pertaining to my unpaid internship, including related assignments and reports.
Under no circumstances will Interns leave the internship without first conferring with the Intern supervisor.
Under no circumstances will the Interns arrive late or be absent without notifying the supervisor in advance.
Transportation to and from the internship site is the sole responsibility of the Intern.
While Intern is on the premises of the Umbra Institute and/or company premises, he/she is considered a “student” intern worker and not an employee.
I have chosen to undertake the internship program voluntarily.
I have or will have current, valid international health insurance coverage for the duration of my internship as required by law. Upon request, I will submit evidence of such coverage.
As an Intern, I assume all the risks of participating in the internship program. In consideration of the opportunity afforded to the Intern to participate in the internship program, the Intern hereby agrees that he/she, his/her assignees, heirs, guardians, and legal representatives, will not make a claim against the Institute and/or the company or any of its affiliated organizations, or either of their officers or directors collectively or individually, or any of its employees, for the injury of death to Intern or damage to his/her property, however caused, arising from his/her participation in the internship program. Without limiting the generality of the foregoing. Intern hereby waives and releases any rights, actions, or causes or action resulting from personal injury or death to him/her, or damage to his/her property, sustained in connection with his/her participation in the internship program.
Any dispute arising from this Agreement will be determined according to Italian Law.

Agreement*

I understand that this unpaid, learning experience is not employment and that Interns are not entitled to wages or a promise of employment at the completion of the learning experience.

Agreement*

I acknowledge that I have had an opportunity to ask questions about the terms of this agreement. I have read and understand the document, I accept its terms, and I sign it knowingly and voluntarily.

Agreement*

In signing this document, I certify that I am at least 18 years old.

Waivers and Agreements

The following pages contain a series of waivers and agreements relative to your time with ISI Perugia - Umbra Institute. We ask that you click each link and read the documents carefully and completely. You are encouraged to bookmark each page for future reference.

Should you have any questions about any of the forms, please don't hesitate to contact your admissions advisor.

Waiver of Liability, Hold Harmless and Release

Click to read the full Waiver of Liability, Hold Harmless and Release text as it applies to you

In signing this release, I acknowledge and represent that I have read the foregoing Waiver of Liability and Hold Harmless Agreement, and understand it as my own free act and deed; no oral representations, statements, or inducements, apart from the foregoing written agreement, have been made; I am at least eighteen (18) years of age and fully competent; and I execute this release for full, adequate and complete consideration fully intending to be bound by the same.

Consent*

I have read and understood the Umbra Institute Waiver of Liability, Hold Harmless and Release accessed above

Student Code of Conduct

Click to read the full Student Code of Conduct text as it applies to you

Consent*

I have read and understood the Umbra Institute Student Code of Conduct accessed above

Covid-19 Assumption of Risk Waiver and Release Statement

Click to read the full Covid-19 Assumption of Risk Waiver and Release Statement text as it applies to you

I have carefully read this Assumption of Risk, Waiver, and Release before agreeing to it and enter into it voluntarily in consideration of the opportunity to participate in the Umbra Institute study abroad activity. I acknowledge that I am giving up legal rights and/or remedies which may be available to me.  

In signing this release, I acknowledge and represent that I have read it completely and was given the opportunity to ask questions, and understand it as my own free act and deed; no oral representations, statements, or inducements, apart from the foregoing written agreement, have been made; I am at least eighteen (18) years of age and fully competent; and I execute this release for full, adequate and complete consideration fully intending to be bound by the same.

Covid-19 Assumption of Risk Waiver*

I have read and fully understand the Umbra Institute Covid-19 Assumption of Risk Waiver and Release Agreement. I accept the conditions as stated.

European Union Privacy Compliance (GDPR)

Click to read the full GDPR text as it applies to you
The Umbra Institute follows all privacy regulations relative to EU and US law.

GDPR Agreement*

I have read and fully understand the Umbra Institute GDPR form. I accept the conditions as stated.

Umbra Institute Participation Agreement

Please read and make sure you understand clearly the clauses and implications of this agreement. By electronically signing the Participation form, you are accepting the terms and conditions of this document.
I, the undersigned, agree that, in keeping with the objectives of the program, I am expected to abide by behavior policies and participation conditions defined by the Institute and my home school or provider.

I understand that my conduct during the program inside and outside the classroom reflects upon my sending institution and the Institute. I acknowledge that I have received, read, understood, and agree to abide by the Policies of the following documents:

Student Pre-Departure Handbook

Student Conduct Code

Waiver of LIabilty, Hold Harmless and Release

Housing Agreement

Covid-19 Assumption of Risk Waiver and Release

European Union Privacy Compliance (GDPR) Agreement
I will also abide by the laws and respect the customs of the host country.
As a result of this agreement, I authorize the Institute, and its authorized agents, to contact the emergency numbers that I have listed, and provide information about any health or safety emergency, or any allegation of misconduct. I further expressly authorize the law enforcement officers to contact the Institute in the event that I am detained, arrested or stopped by them for a misdemeanor or any other transgression.

I understand that the Institute may share information regarding academic, emergency, medical, disciplinary, legal and health-related issues with those that have a need to know including but not limited to my home campus, health care providers, and emergency contacts. If at any time any of the Institute’s programs activities are canceled or curtailed by circumstances beyond the Institute’s control (government intervention, health emergencies, force majeure, etc.), there will be no refunds but I will be permitted to receive full academic credit for courses in which I have enrolled.

I hereby agree to comply with the above-mentioned conditions of participation as well as all other policies, guidelines and regulations of the Institute which have all been made available to me. Should my conduct during supervised or unsupervised time put myself or my colleagues at risk, I understand that the Director of the Umbra Institute has the right, responsibility, and sole discretion to levy whatever sanctions are deemed appropriate, including immediate dismissal from both the program. Upon notification of my dismissal, I understand that I am no longer enrolled in the program, and therefore am responsible for my own lodging and travel arrangements, and forfeit all course credit, program fees, and all other associated fees.

Umbra Institute Participation Agreement*

I have read and fully understood the content of each Umbra Institute waiver provided in this form. By signing, I agree to and accept all of the conditions described.

Today's Date*

Your Signature*

Internship Participant Form

Umbra Institute Form for Interns

Personal Details

Program Selection

Emergency Contact/Parent/Guardian 1

Emergency Contact/Parent/Guardian 2

INTERNSHIP AGREEMENT

Waivers and Agreements

Waiver of Liability, Hold Harmless and Release

Student Code of Conduct

Covid-19 Assumption of Risk Waiver and Release Statement

European Union Privacy Compliance (GDPR)

Housing Placement Form

Student & Intern Housing Agreement

Umbra Institute Participation Agreement

Umbra Institute Participation Agreement