Upload
others
View
7
Download
0
Embed Size (px)
Citation preview
HHP Internship Handbook (Revised 09/15)
Academic Year 2016-2017
Health & Human Performance Department
University of Wisconsin - Superior
Marcovich Wellness Center
Superior, WI 54880
2
Table of Contents
Application Time Table 3
UW-Superior Contacts 4
Program/Objectives 5-7
Process Guide 8
Weekly Reflection 9
Notebook Final Report Suggested Outline 10
Daily Log/Weekly Reflection 11
Exit Interview Form 12
Intern Performance Evaluation 13-16
Student Information Sheet (for Internship Supervisor) 17
Student Information Sheet (for Advisor) 18
Student, Site, and Departmental Internship Agreement Form 19-20
Student Internship Agreement Form 21
Application for Internship 22
3
INTERNSHIP APPLICATION TIME TABLE
University of Wisconsin-Superior
Health and Human Performance Department
Internship Semester Internship application due to
advisor/department
Applications due to all
potential internship sites
Summer/Fall 2016 October 2th, 2015 February 5th, 2016
Spring 2017 February 19th, 2016 September 23rd, 2016
Summer/Fall 2017 October 7th, 2016 February 3rd, 2017
4
UW-Superior Contacts
Mr. Glenn Carlson, Chair
1404 MWC (715) 395-4650 [email protected]
Robin Lisdahl, Academic Department Associate
1402 MWC (715) 395-4673 [email protected]
Career Services ……………….……...… (715) 394-8024
Cashier’s Office ………………………… (715) 394-8505
Financial Aid Office ……………………. (715) 394-8200
Registrar’s Office …………………........ (715) 394-8228
HHP Office ……………………………... (715) 395-4673
HHP FAX ………………………………. (715) 395-4636
HHP Website …………………………… http://www.uwsuper.edu/acaddept/hhp
5
HHP Department and Academic Service-Learning Internship Program/Objectives
Objectives: The HHP Department and Academic Service-Learning (AS-L) internship program is designed to provide
an opportunity for students to gain valuable practical experience in an external/professional setting which
is aligned within their individual career or graduate study program goals while serving a community need.
Through an internship, the student can apply the knowledge they have learned through their educational
curriculum to a career setting or an advanced program of study. The intent is to expand static knowledge
in a dynamic setting and to assist the intern site in a productive manner while further addressing the health
needs within a community. The internship experience allows students to contribute to the health and
wellness of clients and/or employees at their chosen site. The intern site has an opportunity to evaluate a
potential employee and give current employees additional leadership experience as they mentor the intern.
Feedback to the university on the internship program will help shape the source of future internships.
Time Frame:
An internship requires a minimum of 450 hours per semester based on a typical work week of 40 hours.
It can range from 450-600 hours a semester.
A student is awarded 1 credit for each 45 hours of internship provided that the student completes all
required academic assignments associated with the internship. The credit is awarded on a graded basis.
Student Preparation for Internship:
Typically students undertake an internship during their last semester prior to graduation. All coursework
in the major and minor must be completed at a level of C or higher. A cumulative GPA of 2.75 is
required. Students are allowed to take one course during their internship. This course should not
interfere with the internship.
All students completing an internship are advised on the protocol and expectations of an intern. Students
are advised to research intern sites in detail prior to applying for the internship. Critical issues such as
ethics, confidentiality, and conduct are discussed with the students prior to beginning the internship.
Senior Capstone Experience:
HHP 497 in the majority of cases is registered concurrently with HHP 496 (Internship) during a student’s
final semester prior to graduation. This culminating senior year project integrates and synthesizes the
student's coursework (theories, concepts, skill competencies) into a formal project and experience to be
presented on Senior Presentation day (see below for details).
Senior Presentation:
At the culmination of the internship, students are required to create a poster board or develop a five to ten
minute interactive, media oriented presentation on a topic related to the experience and knowledge gained
during their internship activity. Senior Year Experience presentations are typically scheduled on the last
day of classes each semester, from 12:00-2:00 p.m. This is a public presentation. HHP students, parents,
and the campus community are invited to attend. Faculty and staff evaluate the presentations in writing.
The presenter will have a chance to evaluate the presentation, and each advisor will then meet with the
presenter to review the evaluations and gain feedback.
*Summer Interns – students completing their internship during the summer are required to submit their
presentation, in addition to their final notebook, to the D2L dropbox upon the culmination of their
internship.
6
HHP Department and AS-L Internship Program of Study:
The University of Wisconsin Superior aims to bridge the gap between educational concepts taught in the
classroom, with real life job requirements/needs. This professional internship offers the student a
professional experience in their chosen career field and allows the university to build professional
relationships with organizations around the community and beyond. It is the desire of both the university,
Health & Human Performance department, and the UWS student to assist the organization in public
health projects, employee wellness programs, health and wellness awareness projects, and community
outreach activities and beyond.
With the integration of Academic Service-Learning into the HHP internship program the students have a
greater opportunity to link knowledge gained from their education with community needs. Community
partnerships have been formed with local organizations and a Community Internship Guide has been
created to assist students in choosing a site. Included in the guide are job descriptions and contact
information for several local businesses/organizations. Interns may choose an internship site based on
their future career path with consultation of their advisor. We would also be glad to work directly with an
intern site in establishing a specialized internship program of study for those sites not listed in the guide.
Minimum Standards for Internship Eligibility:
To be eligible for an internship the student must:
Meet the GPA requirement of 2.75 and/or internship site requirement
Obtain advisor permission
Complete the Application for Internship (page 22) identifying a confirmed internship site or
supplying 3 or more internship sites being researched as possible sites including contact
information and logistical plan for completion
Hold current certification in CPR and First Aid and any other preferred certifications for career
path
Competitive internships require a high G.P.A. Typically a 3.5 is the minimum standard.
Internships must be outside your current job description.
Jacket Internship Financial Assistance Program (JIFA) - Financial assistance may be available
for unpaid internships. Please contact Career Services to see if you are eligible for this
program.
7
Internship Objectives:
The internship will assist the student in facilitating advanced professional preparation in an
external/professional setting through the following objectives. These objectives and activities include, but
are not limited to:
1) The student will demonstrate competence to apply, analyze, and evaluate the basic knowledge based
objectives found in Health and Human Performance programs.
2) The student will demonstrate the ability to professionally collaborate in an external/professional
setting.
3) The student will demonstrate practical organizational aptitude as evidenced by the development and
maintenance of a three ring internship notebook consisting of weekly reports which include days,
dates, times, and a summary of activities, and on site supervisor formative evaluations.
4) The student will demonstrate scholarly reflection of professional practice in an observational context
as evidenced by successful completion of a written summary and an oral/media presentation.
Responsibilities within the Internship:
Minimum responsibilities for the HHP Internship Student include:
1) Meeting all application requirements and deadlines with advisor support;
2) Enrollment in the appropriate internship course;
3) Attending all required HHP internship meetings;
4) Successful completion of all internship course requirements;
a) Weekly reports are to be submitted electronically each week
5) Development and maintenance of a three ring internship notebook;
6) Identification of an on-site supervisor for the internship;
7) Interns must be evaluated by their site supervisor a minimum of three times throughout
the internship and during the final week.
8) Interns must meet outcomes of the site as described in their internship position
description;
9) Required Senior Capstone Experience presentation during Senior Presentation Day.
Minimum responsibilities for the on-site supervisor include:
1) Signatory agreement to serve as on-site supervisor for the HHP student;
2) Active involvement with the HHP student;
3) Written assessment of the intern’s progress toward goals and objectives;
4) Activity & hour verification of experiences for the HHP intern;
5) Provision of professional mentoring for the HHP student; and,
6) Perform written formative/summative professional evaluations of the HHP intern a
minimum of three times throughout the internship and during the final week.
Problems within the Internship:
If you encounter difficulties within the internship do not wait until the end of the experience to resolve
them. As soon as you suspect difficulty, use the following sequence:
1) Meet face-to-face with the on-site supervisor;
2) If still not resolved, contact your advisor or Department Chair.
Grading:
The final grade for this course is letter graded. Upon completion of ALL course requirements, a final
grade shall be recorded.
8
INTERNSHIP PROCESS GUIDE
University of Wisconsin-Superior
Department of Health and Human Performance
Responsibilities Prior to Internship:
Students are required to:
10) Self-assess professional career goals and research potential internship sites (see HHP
Community Internship Guide).
11) Two (2) semesters prior to internship, during advisement week, meet and discuss
internship handbook, including forms and assignments, start paperwork, and submit
Application for Internship (page 22) to HHP Main Office (MWC 1402).
12) One (1) semester prior to internship student is to locate/apply to/or make contact with
potential internship sites.
13) Once an internship site is established the student is to complete the following forms with
the assistance of their advisor and submit them to the appropriate person as designated on
the bottom of each form: Student Information Sheets (pages 17 & 18), Student, Site, and
Department Agreement Form (page 19 & 20), and the Student Internship Agreement
Form (page 21).
Advisors are required to:
1) Make contact with internship site supervisor (by phone and/or e-mail) prior to or during
the first week of the internship, to establish a professional relationship and opening lines
of communication to address concerns, questions, or issues that may arise.
Responsibilities During Internship:
Students are required to:
1) Complete a Daily Log (page 10)
2) Complete a Weekly Reflection (page 9) and submit to the D2L dropbox per the online
directions.
3) Compile materials for internship notebook (binder) (page 11).
Advisors are required to:
1) Check in with student intern and/or site supervisor to assess how the internship
experience is going and to address any concerns, questions, or issues.
Responsibilities Upon Completion of the Internship:
Students are required to:
1) Submit a professional notebook (binder) of all portfolio requirements
2) Complete a professional presentation (poster board or PPT which will be determined by
advisor) of the internship experience per the requirements outlined by the advisor.
3) Complete a public presentation of either their poster board or PPT.
4) Meet with their advisor one week prior to the public presentation to assess materials.
5) Complete an exit interview with their advisor.
9
INTERNSHIP WEEKLY REFLECTION
University of Wisconsin-Superior
Department of Health & Human Performance
The Internship Daily Log (page 10) must be completed prior to completing your Weekly Reflection.
Submit weekly reflections every Sunday by midnight.
Directions: Submit a Word document reflecting upon your experiences this week. The reflection should
consist of four paragraphs as described below. Include your name and week that you are reflecting upon.
1. What did you do this week? (summarize the daily log)
2. How did you apply existing knowledge and/or new knowledge to your internship assignments
this week?
3. How do you feel about your performance this week and your ability to be successful? (provide
detailed examples) What could have helped you to be more successful?
4. How can you apply what you learned this week to your future goals?
The information requested by the University of Wisconsin-Superior will not be used for purposes other
than it is collected. (WI Act 39)
10
INTERNSHIP NOTEBOOK FINAL REPORT (Suggested Outline)
University of Wisconsin-Superior
Department of Health & Human Performance
I. Introduction
How did you get the internship, inclusive dates of internship, weekly work schedule, rate of
pay, etc?
II. Background
History of the intern site – date founded, by whom, growth statistics.
Organizational structure of the firm including organization chart with titles and names,
number of employees, name and position of your supervisor, nature of business, its
competitors, product/service lines, mission and goals, principle shareholders.
III. Objectives of the Internship
Summarize your learning objectives.
Which of your objectives you achieved and how.
Which of your objectives you did not accomplish and why.
Learning you accomplished that was not included in your objectives. This is usually
quite significant and includes office politics, person-to-person relationships,
characteristics and skills required for advancement, etc.
Which aspects of your classroom learning were helpful and provided you with
knowledge/skills required on the job and why.
Things you wish you would have learned/known prior to starting the internship and why.
IV. Detailed description of the actual work you did, projects completed, and your
accomplishments. This is the major portion of your report. Be sure to clearly describe what
you did, keeping in mind that you want the reader to be able to understand what you write
even though he/she may know little, if anything, about the day-to-day operations of the intern
site. You should include copies of appropriate forms and projects in the appendix, but
describe their development in this section.
V. Summary and conclusions
Your general reactions to the internship – good bad points, your analysis of the management
of the intern site, things you would change if you could, etc. Would you like to work for this
site or one like it after graduation? What would you tell a fellow student about to begin an
internship with the same site/supervisor, etc.? (Anything you want kept confidential will not,
obviously, be included in the copy of the report provided to your supervisor.)
VI. Appendixes
Copies of forms and reports you worked on, computer programs developed, systems created,
etc.
The information requested by the University of Wisconsin-Superior will not be used for purposes other
than it is collected. (WI Act 39)
**To
be su
bm
itted to th
e D2
L dro
pb
ox ea
ch w
eek**
To:
D
ate: __
_______
______
________
From
: __
_______
______
________
Re:
Inte
rnsh
ip D
aily Log/W
eekly Re
po
rt
D
ate H
ou
rs Wo
rked
Du
ties/Acco
mp
lishm
ents
Mo
nd
ay:
Tuesd
ay:
We
dn
esday:
Thu
rsday:
Friday:
Co
mm
ents:
12
HHP INTERNSHIP - EXIT INTERVIEW FORM
University of Wisconsin-Superior
Department of Health and Human Performance
Student’s Name: _______________________________________________________________
Internship Site: _________________________________________________________________
Name of Internship Supervisor: _____________________________________________________
Beginning and End Dates of the Internship: ___________________________________________
Date of Exit Interview: ___________________________________________________________
_____Objectives were planned and clearly stated prior to internship.
_____Objectives have been achieved through appropriate learning activities.
_____All basic requirements and responsibilities have been met.
Student Comments:
Advisor Comments:
Department Chair Comments:
___________________________________ _______________
Signature – Student Date
___________________________________ _______________
Signature – Advisor Date
___________________________________ _______________
Signature – Department Chair Date
13
INTERNSHIP PERFORMANCE EVALUATION (4 pages) University of Wisconsin-Superior
Department of Health & Human Performance
Intern Name: ________________________________Position: __________________________________
This form should be completed by the individual in the best position to evaluate the student's performance
[the internship supervisor unless he/she is not available]. Appraisals should be made only for those
performance and work habits categories where the supervisor feels reasonably competent to judge the
individual accurately. The evaluator is encouraged to qualify his/her evaluation in areas where further
information would be helpful under supervisor's comments. Evaluations should be reviewed with the
student and then sent to the student’s advisor after the final evaluation has been completed and reviewed
with the intern/student.
Please rate the student using the scale 5-0, with 5 being the highest and 0 being the lowest score possible.
The HHP department requests that the intern/student be evaluated at the end of weeks 3,7,12 and the final
week of the internship experience.
Quality of Work Week 3 Week 7 Week 12 Final Week
5 - Very thorough in performing work.
Errors very few if any.
4 - High level of quality. Requires only
occasional correction.
3 - Work usually passes review. Has
normal amount of errors.
2 - Erratic quality. Not thorough. Work
requires review.
1 - Work usually done in careless manner.
Makes errors often.
0 - Not Measurable
Quantity of Work Week 3 Week 7 Week 12 Final Week
5 - Exceptionally fast and efficient. Often
handles extra assignments.
4 - Goals and deadlines always met,
usually ahead of schedule. Willing to
handle extra tasks.
3 - Steady results. Usually completes
assignments on time.
2 - Frequently late in completing
assignments. Needs prodding.
1 - Very slow and wastes time. Seldom
gets work done on time. Work done in
careless manner.
0 - Not Measurable
14
Communication Skills - Written Week 3 Week 7 Week 12 Final Week
5 - Exceptional performance with written
communication skills.
4 - Consistently submits written
communication which is clear, precise, and
timely.
3 - Can be counted on to complete written
reports clearly.
2 - Needs improvement in writing skills.
1 - Writes poorly. Improvement must be
shown.
0 - Not Measurable
Communication Skills - Verbal Week 3 Week 7 Week 12 Final Week
5 - Exceptional performance with verbal
communication skills.
4 - Accomplished speaker in front of
group.
3 - Above average making presentations.
2 - Needs to improve presentation skills.
1 - Makes unsatisfactory presentations.
0 - Not Measurable
Attendance Week 3 Week 7 Week 12 Final Week
Regular or Irregular
Days Missed
Punctuality Week 3 Week 7 Week 12 Final Week
Regular or Irregular
Days Missed
Initiative Week 3 Week 7 Week 12 Final Week
5 - Self-starter. Seeks challenges, asks for
more work. Attacks problems and solves
them on own.
4 - Works with minimum supervision.
Usually finds problems to solve. Usually
sets own goals and tries to exceed
requirements.
3 - Puts generally good effort into work.
Meets standards. Does not often
procrastinate.
2 - Shows minimum interest in meeting
standards. Requires close supervision.
Frequent procrastination.
1 - Has little observable drive or energy.
Habitual procrastinator, moves only when
prodded.
0 - Not Measurable
15
Dependability Week 3 Week 7 Week 12 Final Week
5 - Always follows instructions well.
Extremely reliable. Functions consistently
at standard of excellence.
4 - Requires very little supervision. Very
reliable when he/she gives information.
3 - Attempts to do what is asked. Tries to
be accurate. Information he/she gives may
have to be verified periodically.
2 - Requires more supervision, training and
follow-up than most students. May at times
mislead supervisor.
1 - Does not follow instructions promptly
or accurately. Very careless. Constant
follow-up required.
0 - Not Measurable
Cooperativeness Week 3 Week 7 Week 12 Final Week
5 - Always works in harmony with others.
An excellent team worker.
4 - Congenial and helpful. Works well with
associates.
3 - Most relations with others are
harmonious under normal circumstances.
2 - Difficult to work with at times.
Sometimes antagonizes others.
1 - Frequently quarrelsome and causes
friction.
0 - Not Measurable
Judgement Week 3 Week 7 Week 12 Final Week
5 - Demonstrates unusual ability to
develop alternatives and makes sound
decisions based on knowledge available.
Openly accepts responsibility for
decisions.
4 - Demonstrates good methodical thought
processes. Good problem-solving logic.
Seeks counsel when necessary.
3 - Makes only routine decisions based
upon established policies and knowledge.
Occasionally develops alternatives.
Generally seeks counsel.
2 - Lacks confidence to make routine
decisions. Seeks supervision or other
assistance to avoid responsibility.
1 - Demonstrates inability to reason and
cope with job responsibilities.
0 - Not Measurable
16
Diligence Week 3 Week 7 Week 12 Final Week
5 - Persistently and effectively utilizes
time, tools, and resources within the scope
of the job without being told.
4 - Rarely shows lack of persistence in
utilizing resource effectively. Very
thorough and careful with details.
3 - Occasionally makes mistakes. Learns
from them however and eliminates future
occurrences without prodding.
2 - Sometimes has to do jobs more than
once to achieve objectives. Tries to learn
from mistakes.
1 - Rarely does job right the first time. Is a
source of errors. Requires constant
reminding.
0 - Not Measurable
Leadership Week 3 Week 7 Week 12 Final Week
5 - Has high desire for achievement.
Demonstrates tactfulness. Sets excellent
example for other students.
4 - Almost always calm with very good
tolerance level. Accepts new challenges
well. Sets good example.
3 - Usually calm and tactful. Displays
patience in working with others. Tries to
learn from criticism.
2 - Sometimes tactless or inconsiderate of
others. Reluctantly accepts criticism and
ideas of others.
1 - Very critical of peers, subordinates and
management. Suspicious of others'
intentions. Content to do minimum
required.
0 - Not Measurable
Supervisors Comments: Specify significant accomplishments or lack of accomplishments by the
individual during the review period.
_____________________________________________________________________________________
_____________________________________________________________________________________________________________________
_____________________________________________________________________________________________________________________
_____________________________________________________________________________________________________________________
_____________________________________________________________________________________________________________________
_____________________________________________________________________________________________________________________
17
STUDENT INFORMATION SHEET (FOR INTERNSHIP SUPERVISOR)
University of Wisconsin-Superior
Department of Health & Human Performance
Student Name: _______________________________________________
Degree/Program: _____________________________________________
Student Contact Information:
Phone ( ) - _______-_______
E-mail [email protected]
Advisor Name: ________________________________________________
Advisor Contact Information: ____________________________________
Phone ( ) - _______-_______
E-mail __________________@_______________
Internship Start Date: _____________ Tentative End Date: ______________
Total hours required: ________
UWS – HHP Department Contact Information:
Phone: 715-395-4673
Fax: 715-395-4636
E-mail: [email protected]
**Return completed form (prior to the start of the internship) to the internship site supervisor**
18
STUDENT INFORMATION SHEET (FOR ADVISOR)
University of Wisconsin-Superior
Department of Health & Human Performance
Student Name: _______________________________________________
Degree/Program: _____________________________________________
Student Contact Information:
Phone ( ) - _______-_______
E-mail [email protected]
Internship Organization Name: ___________________________________
Internship Supervisor Name: ____________________________________
Internship Supervisor Contact Information:
Phone ( ) - _______-_______
E-mail __________________@_______________
Internship Start Date: _____________ Tentative End Date: ______________
Total hours required: ________
**Return completed form (prior to the start of the internship) to advisor**
19
STUDENT, INTERNSHIP SITE, AND HHP DEPARTMENT AGREEMENT FORM (page 1 of 2)
University of Wisconsin-Superior
Department of Health & Human Performance
Student Name: Student E-mail Address:
Local Address: Local Telephone Number:
Major(s): Number of Internship Credits to be Taken:
Internship Site: Internship Site Address:
Internship Supervisor: Internship Supervisor’s Telephone Number:
Instructions: Prior to obtaining the signatures below: Complete this form with the assistance of your
advisor. Include your learning objectives and goals in the Objectives/Learning Activities section.
_____________________________________________ ____________
Student Signature Date
_____________________________________________ ____________
Employer or Supervisor Signature Date
_____________________________________________ ____________
Academic Advisor Signature Date
_____________________________________________ ____________
Department Chair Signature/Instructor of Record Date
Copy to:
□ Student
□ Advisor
□ Supervisor (if applicable)
□ Instructor of Record
20
STUDENT, INTERNSHIP SITE, AND HHP DEPARTMENT AGREEMENT FORM (page 2 of 2)
Title of Internship: ________________________________________________________________
Starting Date: _______________________Approximate Ending Date: ______________________
Instructions: Complete the information below. Be as thorough and specific as possible. The accepted
standard for an internship is 450 hours of work per 10 credits.
Objectives: (What do you want to accomplish? Be specific.)
Learning Activities: (What will you do to achieve the above objectives? Include the estimated number
of hours.)
Evaluation: (How will the site supervisor and/or instructor determine if you have achieved the above
objectives? A final written report is required.)
The student intern agrees to perform all assigned duties to the best of his or her ability and to submit all
required academic reports. The employer agrees to provide a supervised schedule of work that
corresponds with the learning activities listed above, to review the intern’s final report for accuracy and
quality, and to submit a written evaluation of the intern’s performance.
The information requested by the University of Wisconsin-Superior will not be used for purposes other
than it is collected. (WI Act 39)
**Return completed form (prior to the start of the internship) to HHP ADA (MWC 1402)**
21
STUDENT INTERNSHIP AGREEMENT FORM
UW-Superior Department of Health & Human Performance
Eligibility Requirements and Enrollment Procedures
1. Submit an Application for Internship form by designated date as referenced on the Internship
Application Time Table.
2. Minimum 2.75 grade point average. Employers may establish higher minimums.
3. Successful completion of all major / minor coursework at the C level or higher.
4. Submit a current advising report.
5. Register for the appropriate courses and credits (HHP 496) and any other courses as needed.
6. Submit applications to potential internship sites by designated date as referenced on Internship
Application Time Table.
7. Once a site has been agreed upon the student notifies their advisor/HHP ADA so the department
can initiate an Affiliation Agreement.
8. Students should note that successful completion of a criminal background check may be required
by the internship site prior to placement.
9. Completion of a caregiver or clinical background study may also be required by the internship
site prior to placement. This will include proof of current immunizations.
10. With the assistance of your advisor and the prospective employer, complete the Internship
Agreement and obtain the required signatures.
Student Responsibilities
1. Perform all duties assigned by site supervisor in a cheerful, timely, and competent manner,
keeping in mind that nothing less than outstanding performance is expected that will reflect well
on the University of Wisconsin-Superior.
2. Complete and submit Internship weekly reports.
3. Meet with your advisor at the beginning and end of the semester. At the initial meeting a current
degree audit must be present.
4. Complete a comprehensive final reflection on the internship experience and complete an
oral/media/poster presentation on Senior Presentation Day. The reflection must be typed and is to
be a minimum of five pages long, double-spaced, 12 font.
5. Submit the final site supervisor’s evaluation prior to the oral/media/poster presentation.
I have read and understand the student responsibilities and have been given a copy of a suggested
outline for the final report.
_______________________________________ ____________
Intern Date
_______________________________________ ____________
Advisor Date
The information requested by the University of Wisconsin-Superior will not be used for purposes other
than it is collected. (WI Act 39)
**Return completed form (prior to the start of the internship) to HHP ADA (MWC 1402)**
22
Health and Human Performance Department
APPLICATION FOR INTERNSHIP
Name:
Date:
SID:
Advisor:
Major:
Minor:
Total Credits to Date:
Cumulative GPA:
Anticipated Date of Graduation:
Internship to be Completed (Semester/Year):
**Please Attach Current Advising Report to Application**
Preferred Internship Sites:
1. ___________________________________________________
2. ___________________________________________________
3. ___________________________________________________
4. ___________________________________________________
5. ___________________________________________________
(Suggested Minimum of 3 Sites) – See Community Internship Guide
Date Applied:
____________
____________
____________
____________
____________
Student Signature:
Office Use Only -
Date Application Received:
Affiliation Agreement Received:
Student Contract Received:
**Return completed form to HHP Academic Department Assistant (MWC 1402)**