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HHP Internship Handbook (Revised 09/15) Academic Year 2016-2017 Health & Human Performance Department University of Wisconsin - Superior Marcovich Wellness Center Superior, WI 54880

HHP Internship Handbook - UW-Superior · presented on Senior Presentation day (see below for details). Senior Presentation: At the culmination of the internship, students are required

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Page 1: HHP Internship Handbook - UW-Superior · presented on Senior Presentation day (see below for details). Senior Presentation: At the culmination of the internship, students are required

HHP Internship Handbook (Revised 09/15)

Academic Year 2016-2017

Health & Human Performance Department

University of Wisconsin - Superior

Marcovich Wellness Center

Superior, WI 54880

Page 2: HHP Internship Handbook - UW-Superior · presented on Senior Presentation day (see below for details). Senior Presentation: At the culmination of the internship, students are required

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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

Page 3: HHP Internship Handbook - UW-Superior · presented on Senior Presentation day (see below for details). Senior Presentation: At the culmination of the internship, students are required

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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

Page 4: HHP Internship Handbook - UW-Superior · presented on Senior Presentation day (see below for details). Senior Presentation: At the culmination of the internship, students are required

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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

Page 5: HHP Internship Handbook - UW-Superior · presented on Senior Presentation day (see below for details). Senior Presentation: At the culmination of the internship, students are required

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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.

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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.

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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.

Page 8: HHP Internship Handbook - UW-Superior · presented on Senior Presentation day (see below for details). Senior Presentation: At the culmination of the internship, students are required

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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.

Page 9: HHP Internship Handbook - UW-Superior · presented on Senior Presentation day (see below for details). Senior Presentation: At the culmination of the internship, students are required

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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)

Page 10: HHP Internship Handbook - UW-Superior · presented on Senior Presentation day (see below for details). Senior Presentation: At the culmination of the internship, students are required

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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)

Page 11: HHP Internship Handbook - UW-Superior · presented on Senior Presentation day (see below for details). Senior Presentation: At the culmination of the internship, students are required

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Page 12: HHP Internship Handbook - UW-Superior · presented on Senior Presentation day (see below for details). Senior Presentation: At the culmination of the internship, students are required

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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

Page 13: HHP Internship Handbook - UW-Superior · presented on Senior Presentation day (see below for details). Senior Presentation: At the culmination of the internship, students are required

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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

Page 14: HHP Internship Handbook - UW-Superior · presented on Senior Presentation day (see below for details). Senior Presentation: At the culmination of the internship, students are required

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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

Page 15: HHP Internship Handbook - UW-Superior · presented on Senior Presentation day (see below for details). Senior Presentation: At the culmination of the internship, students are required

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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

Page 16: HHP Internship Handbook - UW-Superior · presented on Senior Presentation day (see below for details). Senior Presentation: At the culmination of the internship, students are required

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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.

_____________________________________________________________________________________

_____________________________________________________________________________________________________________________

_____________________________________________________________________________________________________________________

_____________________________________________________________________________________________________________________

_____________________________________________________________________________________________________________________

_____________________________________________________________________________________________________________________

Page 17: HHP Internship Handbook - UW-Superior · presented on Senior Presentation day (see below for details). Senior Presentation: At the culmination of the internship, students are required

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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**

Page 18: HHP Internship Handbook - UW-Superior · presented on Senior Presentation day (see below for details). Senior Presentation: At the culmination of the internship, students are required

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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**

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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

Page 20: HHP Internship Handbook - UW-Superior · presented on Senior Presentation day (see below for details). Senior Presentation: At the culmination of the internship, students are required

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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)**

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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)**

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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)**