IIC Intern Agreement Adjustments

Form Code*

Intern Name*

First NameLast Name
Agency*
NPS, USFS, BLM, SUU, etc
Agency Location*
Agency Mentor*

First NameLast Name
Mentor Email*
example@example.com
Name of Preparer*

First NameLast Name
Interns Currently Weekly Hours
Effective Start Date*

MonthDayYear
Date
Effective start date must be the 1st or 16th of the month.
Categories - Select all that apply*

Merit RaiseAdding Travel FundsChanging Funding AgreementChanging Project CodeAdditions or Changes to DutiesInternship Extension (Change End Date)Changing MentorOther
Number of expected weekly hours*
Does this change constitute a change in title?*

YesNo
Please list new title*
Budget adjustments, adding funds to an intern agreement, need to be submitted via the IIC Intern budget form.
Merit Raise

Be aware that increasing an interns pay will affect the existing end date, as the intern will use existing funds at a quicker rate. A new budget may be required. Pay changes must be received at least 1 week prior to making the change in order to accommodate processing.
New Hourly Pay Rate*
Date to be Applied*

MonthDayYear
Date must be the 1st or the 16th of the month to accommodate payroll.
Adding Travel Funds
Total Travel Funds to Add*
Date of Change*

MonthDayYear
Date
Select Relevant Option*

Please take these funds from the existing intern budget (wages and benefits) and apply them to travel instead. This option may affect the interns end datePlease add these funds to the existing intern budget
Changing the Funding Agreement

Please only submit one funding agreement change per form. This helps the IIC keep all requests in order. Changes must be received at least 1 week prior to making the change in order to accommodate processing.
New Funding Agreement Number*
Date to be Applied*

MonthDayYear
Must be the 1st or the 16th of the month to accommodate payroll.
Changing Project Codes

Please only submit up to two project code changes per form. This helps the IIC keep all requests in order. Changes must be received at least 1 week prior to making the change in order to accommodate processing.
New Project Code*
Date to be Applied*

MonthDayYear
Must be the 1st or the 16th of the month to accommodate payroll.
New Project Code*
Date to be Applied*

MonthDayYear
Must be the 1st or the 16th of the month to accommodate payroll.
Additions or Changes to Duties
List new detailed list of intern duties and/or responsibilities*
Date to be Applied*

MonthDayYear
Date
Internship Extension: Change End Date

Additional funds may need to be added to intern budget to accommodate extensions. The IIC will contact you if you need to submit a new budget to accommodate this change.
New Internship End Date*

MonthDayYear
Date
Changing Mentor
New Mentor Name*

First NameLast Name
New Mentor Email*
example@example.com
New Mentor Phone*

Area CodePhone Number
Is this a permanent change?*

YesNo
Start Date*

MonthDayYear
Date
End Date*

MonthDayYear
Date
Is the former mentor no longer with the agency and should the IIC mark them as an inactive mentor*

YesNo
Reason for change*
Should be Empty:

Merit Raise

Adding Travel Funds

Changing the Funding Agreement

Changing Project Codes

Additions or Changes to Duties

Internship Extension: Change End Date

Changing Mentor