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Kinesiology & Health INTERNSHIP HANDBOOK Lewis-Clark State College

INTERNSHIP HANDBOOK · 4 • Time Log • Internship Reflection • Safety Checklist • Site Supervisors Final Evaluation • Feedback about the Internship v. Complete an Oral Presentation

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Page 1: INTERNSHIP HANDBOOK · 4 • Time Log • Internship Reflection • Safety Checklist • Site Supervisors Final Evaluation • Feedback about the Internship v. Complete an Oral Presentation

Kinesiology & Health

INTERNSHIP

HANDBOOK

!

Lewis-Clark State College

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Lewis-Clark State College

Kinesiology and Health Program

Internship &

Practicum

Handbook

Contact Person:

Dr. Betsy Van Clief

208-792-2277

[email protected]

Updated 8/26/2009

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Table of Contents

Program Overview Introduction………………………………………………………………………………….2

Eligibility………………………………………………………………………………….....2

Duties and Expectations Related to all On-Site Field Work……………………...................2

Course Description…………………………………………………………………………..3

Course Requirements For Kin/Hlth/Rec 495 Practicum Students…………………….…….3

Course Requirements For Kin/Hlth/Rec 494 Interns………………………………………..3

Description Of Assignments For Interns And/Or Practicum Students…………………..….4

Grading……………………………………………………………………………………...6

Appendix A: Course Syllabus Syllabus: KIN/HLTH/REC 495……………………………………………………………8

Syllabus: KIN/HLTH/REC 494……………………………………………………..…….14

Appendix B: Forms Student Forms

Checklist of Responsibilities KIN 494……………………………………………20

Checklist of Responsibilities KIN 495……………………………………………21

Initial Site Description…………………………………………………………….22

Site Supervisor and Student Meeting Notes…………………………….…………23

Safety and Liability Checklist…………………………………………...………...24

Internship Reflection………………………………………………………………25

Time Log…………………………………………………………..………………26

Feedback about the Internship…………………………………………….………27

Confidentiality Policy and Agreement……………………………..……………..29

Site Supervisor Forms

Midterm Progress Evaluation………………………………………..……………30

Practicum/Internship Evaluation Form……………………………………………31

Service Learning Agreement……………………………………..……………….33

College Supervisor Forms

Oral Presentation Rubric………………………………………….………………35

Appendix C: Internship Sites……………………………………………..……..36

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1

Program Overview

1. Introduction

2. Eligibility

3. Duties and Expectations Related to all On-Site Field

Work

4. Course Description

5. Course Requirements For Kin/Hlth/Rec 495

Practicum Students

6. Course Requirements For Kin/Hlth/Rec 494

Interns

7. Description Of Assignments For Interns And/Or

Practicum Students

8. Grading

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2

KINESIOLOGY AND HEALTH PROGRAM

Internship & Practicum

PROGRAM OVERVIEW

1. INTRODUCTION The Kinesiology and Health practicum and internship experiences are designed to provide students enrolled in KIN/HLTH/REC 494

or 495 with practical experience at designated sites in the community. Under the supervision of an on-site supervisor and a college

supervisor, students have an opportunity to apply previous classroom learning to real-world problems and solutions at the worksite.

The practicum/internship, usually an unpaid experience, should be mutually rewarding for the student and the supervising

organization.

2. ELIGIBILITY All Kinesiology majors and minors are required to complete at least 3 credits of internship. They are encouraged to gain further

experience in the field with more than the required 3 credits of internship or practicum. Placements are made according to the

student’s career goals and location preferences.

In order to be eligible to begin an Internship each student must meet the following criteria:

a. Completion of most core classes in the program of study

b. Selection of a site from the approved list of practicum/internship sites at the back of this handbook (alternate sites may also be

selected, but must be approved by the College Internship Supervisor

c. Approval of the College Internship Supervisor

d. Approval of the Site Supervisor

3. DUTIES AND EXPECTATIONS RELATED TO ALL ON-SITE FIELD WORK

Although each site offers different experiences and a distinct environment most of the duties and expectations listed below will apply.

It will be important for each student, Site Supervisor and College Supervisor to meet periodically to discuss progress and problems.

The Student will:

• Accomplish assignments that have been agreed upon and meet the needs of the agency and its clients.

• Be responsible for the agreed service hours, and call ahead if going to be late or unable to attend a scheduled shift.

• Follow all policies of the site, including health and safety precautions and confidentiality.

• Not work in a room alone with a client, or transport a client, unless specifically screened and cleared to do so by the agency.

• Notify the supervisor and/or activity director of any problems, concerns, or changes.

• Keep a record of student hours, and present them to the agency if needed.

LCSC will:

• Require students and assigned faculty to conform to the policies and procedures of the Agency.

• Ensure that College Supervisor is available by telephone at all times when the student is in the agency.

• Ensure that students and College Supervisors are informed of, and comply with, all applicable agency rules and regulations.

The Community/Agency Site Supervisor will:

• Involve the student in assignments that support the learning goals, insofar as possible.

• Provide orientation and training.

• Have clear risk management, an emergency plan and personnel policies and procedures in place, and include these in student

training.

• Provide a supervisor to guide and evaluate the student. The supervisor will be present at all times.

• Clarify procedures for the student to report problems, to get assistance, and to make suggestions.

• Complete an evaluation form, if provided.

• Notify the student and/or the activity director of any problems, concerns, or changes.

4. COURSE DESCRIPTION KIN/HLTH/REC 494 and 495 is designed to deliver health, physical education or athletic -related service to a school, agency or

organization that works with an age group of your choice, i.e. children, adolescents, adults or older adults. This option must involve

direct service and must be health or physical education or athletic related.

The course will involve structured opportunities intentionally designed to promote student learning and development. Therefore, it is

highly recommended that students have finished courses related to the services they will be providing at the internship site.

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A course syllabus for KIN/HLTH/REC 495 and KIN/HLTH/REC 494 is included in the Appendix of this Handbook. In each syllabus

you will find details for completing course requirements.

5. COURSE REQUIREMENTS FOR KIN/HLTH/REC 495 PRACTICUM STUDENTS It will be each Practicum student’s responsibility to read and understand the syllabus and to note any changes in the course if they

occur during the semester. In addition, they are asked to keep their own copy (a duplicate) of each assignment.

To earn an “A” in this class the students must satisfactorily complete the following by the end of the Internship:

Prior To Field Experience

a. Enroll in Internship Course (check # of credits and section #)

b. Attend First Internship Class (obtain course syllabus and schedule oral presentation)

c. Review Course Syllabus

d. Review The Health and Kinesiology Practicum/Internship Handbook and other course materials

e. Investigate Sites and provide Site Supervisor with your Resume and a Record of Courses Completed

f. Obtain permission from Site Supervisor to seek site approval from College Supervisor

g. Obtain approval of Initial Site Description from College Supervisor

h. Set up initial meeting with yourself, College Supervisor and Site Supervisor.

i. Provide Internship Site Supervisor with a copy of the The Health and Kinesiology Practicum/Internship Handbook, and the Site

Supervisor Evaluation Form

j. Return the signed Service Learning Agreement (if required)to College Supervisor

k. Get fingerprinted (if this is required by the site) and see that documents are sent to the Site and College Supervisor

During The Field Experience

l. Complete Time Log daily

m. Complete Site Supervisor/Student Meeting Notes

n. Meet with College Supervisor

o. Set up and attend final meeting with College Supervisor and Site Supervisor

p. Obtain completed Site Supervisor Evaluation Form

After The Field Experience

q. Submit Internship Portfolio including:

• Checklist of Responsibilities

• Resume

• Initial Site Description

• Time Log

• Site Supervisors Final Evaluation

6. COURSE REQUIREMENTS FOR KIN/HLTH/REC 494 INTERNS It will be each Intern’s responsibility to read and understand the syllabus and to note any changes in the course if they occur during the

semester. In addition, they are asked to keep their own copy (a duplicate) of each assignment.

To earn an “A” in this class the intern must satisfactorily complete the following by the end of the Internship:

Prior To Internship

a. Enroll in Internship Course (check # of credits and section #)

b. Attend First Internship Class (obtain course syllabus and schedule oral presentation)

c. Review Course Syllabus

d. Review The Health and Kinesiology Practicum/Internship Handbook and other course materials

e. Investigate Sites and provide Site Supervisor with your Resume and a Record of Courses Completed

f. Obtain permission from Site Supervisor to seek site approval from College Supervisor

g. Obtain approval of Initial Site Description from College Supervisor

h. Set up initial meeting with yourself, College Supervisor and Site Supervisor.

i. Provide Internship Site Supervisor with a copy of the The Health and Kinesiology Practicum/Internship Handbook, and the Site

Supervisor Evaluation Form

j. Return the signed Service Learning Agreement (if required)to College Supervisor

k. Get fingerprinted (if this is required by the site) and see that documents are sent to the Site and College Supervisor

During The Internship

l. Complete Time Log daily

m. Complete a Safety/Liability Checklist

n. Complete the Site Supervisor/Student Meeting Notes

o. Attend Small Group Meetings (or alternative if applicable)

p. Obtain completed Progress Report Form from Supervisor and give it to the

q. College Supervisor

r. Meet with College Supervisor

s. Set up and attend final meeting with College Supervisor and Site Supervisor

t. Obtain completed Site Supervisor Evaluation Form

After The Internship

u. Submit Internship Portfolio including:

• Checklist of Responsibilities

• Resume

• Initial Site Description

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4

• Time Log

• Internship Reflection

• Safety Checklist

• Site Supervisors Final Evaluation

• Feedback about the Internship

v. Complete an Oral Presentation

7. DESCRIPTION OF ASSIGNMENTS FOR INTERNS AND/OR PRACTICUM STUDENTS

• Internship site Selection (and check the number of credits in which you are enrolled)

Many students know where and with whom they would like to gain experience in the field. Settings may include day care

centers, recreation programs, schools, public health and community agency programs, nursing homes etc. Preferably, students

should select a service activity that engages them with the population with which they eventually would like to work, and/ or

addresses a health/sport issue in which they are particularly interested.

Students will need to get permission to do the internship/practicum with someone working at the site. This person will be called

the Site Supervisor. It will be the student’s responsibility to provide their Site Supervisor with a copy of his/her resume and a

copy of his/her current degree program plan indicating the courses passed so far.

ALL SITES MUST BE APPROVED BY THE COLLEGE SUPERVISOR.

• Initial Site Description form (see form)

This assignment is due no later than two weeks after the semester begins or after the student adds the course. The instructor will

review the site description and provide approval. Students will keep a copy of the completed Initial Site Description form

because it must be included in the final Portfolio of course assignments.

Students may also be asked to have their Site Supervisor complete a Service Learning

Agreement. The College Supervisor will provide this form if it is needed at a particular site.

• Supervisor and Student Meeting Notes (see form)

During the first few days of the experience in the field, the student and Site Supervisor will need to discuss items that will be

important to the student’s success. The Supervisor and Student Meeting Notes form should be used to guide the discussion, but

there may be other items about which the Supervisor would like his/her Intern/Practicum student to know.

• Evaluations by the Site Supervisor (see Evaluation forms)

Students will be given a Progress Report form and a Final KIN 494 Site Supervisor Evaluation form to be filled out by the Site

Supervisor. It will be the student’s responsibility to obtain the form, give it to his/her Site Supervisor, get the completed form

back by the due date and place a copy of it in the Portfolio. (All original evaluations should by kept by students to use in their

Kinesiology Senior Portfolio.) The student will not receive full credit if this evaluation is late. If the student does not receive a

satisfactory evaluation, the College Supervisor may decide to give an Incomplete or failing grade in the class.

• Portfolio of Course Assignments

After completing the field experience, each student will submit a Portfolio of Assignments. The portfolio must be neat and

organized and contain the items listed below and in the summary chart under the Grading section of this Handbook.

Students are responsible for making their own copy of all assignments and supervisor evaluations. They should keep the

original copy of their supervisor evaluations and place a copy in the portfolio. Portfolio work may not be returned unless it is

something like pictures, handouts, posters, or other forms of evidence. Kinesiology students will be expected to include items

from their Internship Portfolio, including supervisor evaluations, in the Kinesiology Program Exit Portfolio that will be part of

KIN 499, Senior Seminar and Research/Project.

The Portfolio of Assignments must include:

a. Checklist of Responsibilities (See Form)

The Checklist of Responsibilities form is designed to guide students through the steps needed to successful complete the

Internship or Practicum.

b. Resume

c. Internship/PracticumReflection (see assignment handout)

Students will be given a handout with questions that will help them reflect on their experiences during the semester. Most

of the questions should be answered after they complete their on-site field work.

d. Safety and Liability Checklist (see form)

During their field work students should be fully aware of their responsibility to create a safe environment of all clients,

participants, athletes, etc. Each student is required to complete the Safety and Liability Checklist at least one time during

the field experience.

e. Feedback About the Internship (see form)

This assignment is designed to help the LCSC faculty improve internship experiences in the future.

f. Time Log (see form)

Students will need to record their time out in the field on the form provided. They will receive 1 credit for each 45 hours of

effort toward an internship/practicum experience.

Practicum Time Requirements: For each credit earned they will need to document 40 hours in direct service to or in

actual contact with the individual or population. The rest of the 5 hours must be spent researching assignments, meeting

individually with the College Supervisor, completing the portfolio, and/or attending class.

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Intern Time Requirements: For each credit earned they will need to document 30 hours in direct service to or in actual

contact with the individual or population. The rest of the 15 hours must be spent researching assignments, meeting

individually with the college supervisor, completing their portfolio, preparing for the oral presentation, and attending class.

• Oral Presentation

Before the end of the semester Interns will do an oral presentation about their Internship. To earn an “A” in the class each

Intern must do an oral presentation. In the presentation they should include something they believe would be interesting to

the class.

They must at least provide a summary of the experience that includes the following:

o Describe what they learned about this health/sport issue as it relates to the group with whom they worked.

o Describe what they believe the children/adolescents/adults they worked with got out of the experience

o Describe what they learned about themselves and what they gained as a result of delivering this service.

They may showcase their internship experience using a variety of formats including:

o Pictorial - photo essays with captions, poster, billboard/bulletin board, illustration or power point presentation

o Verbal presentation - poetry, story telling, verbal histories or case studies

o Dramatization: creative imagery, rap song, puppet show, or dance

o Video Production: scripted or selected event highlights

o Skill Demonstration: demonstrate a skill(s) you learned from your internship experience

• Class/Meeting Attendance

The course is designed so that most students will be able to attend the class. Some flexible times have also been built into

the schedule to better accommodate student schedules. Students will earn credit for attending small group meetings,

individual meetings with the college supervisor and oral presentations.

In addition, each student and College Supervisor will meet with the Site Supervisor(s) immediately after starting the

internship and also for a final oral evaluation of the student’s performance. In most cases, the College Supervisor will

come to observe students on site; in other cases the College Supervisor will conduct communications and evaluations over

the phone. It is the student’s responsibility to set up these meetings and observations.

8. GRADING

The following chart summarizes the class assignments.

Assignment Who Completes % of grade Date Due

Initial Site Description Student 2 2 weeks after adding

the course

Service Learning Agreement Student, Site Supervisor,

College Supervisor

Depends on site 2 weeks after adding

the course

Supervisor & Student Meeting Notes Site Supervisor & Student 5 2 weeks after field

experience begins

Progress Report Site Supervisor 2 Midterm

Communication/meetings with College

Supervisor

10

Portfolio - Submitted on Time and including

the items below:

Student 2

Checklist of Responsibilities Student 2

Resume Student 2

Site Supervisor and Student

Meeting Notes

Student Listed above

Time Log Student and Site Supervisor 65

Site Supervisor’s

Evaluation Form

Site Supervisor 10

Semester End

TOTAL 100%

Student grades will be calculated according to the campus-wide grading scale:

Percentages:

93 -100% =A Exemplary

90 -92.9% =A-

88.0 -89.9% =B+ Proficient

83.0 -87.9% =B

80.0 -82.9% =B-

77.0 -79.9% =C+

74.0 -76.9% =C Good, Average

71.0 -73.9% =C-

68.0 -70.9% =D Below Average, Unsatisfactory

0 -67.9% =F Failing, No academic Credit

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Appendix A

Course Syllabus

o Syllabus: KIN/HLTH/REC 494 Internship

o Syllabus: KIN/HLTH/REC 495 Practicum

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SYLLABUS (Example)

DATE:

COURSE NUMBER AND TITLE: HLTH/KIN 494 INTERNSHIP

CREDIT HOURS: 1-12 credits

ONE CREDIT = 45 HOURS of WORK

INSTRUCTOR:

OFFICE:

OFFICE HOURS:

PHONE:

E-MAIL

COURSE DESCRIPTION This course is designed to deliver health, physical education or athletic -related service to a school, agency or

organization that works with an age group of your choice, i.e. children, adolescents, adults or older adults. This

option must involve direct service and must be health or physical education or athletic related.

The course will involve structured opportunities intentionally designed to promote student learning and

development. Therefore, it is highly recommended that you have finished courses related to the service you will be

providing at your internship site. If you have not done the appropriate coursework, your instructor may ask you to

enroll in a 295 or 495 Practicum instead of the 494 Internship.

COURSE OUTCOMES /PERFORMANCES It will be your responsibility to read and understand this syllabus and to note any changes in the course if they occur

during the semester; please feel free to ask questions. In addition, you must keep your own copy (a duplicate) of

each assignment.

To earn an “A” in this class you must satisfactorily complete the following by the end of this Internship:

PRIOR TO INTERNSHIP

1. Enroll in Internship Course (check # of credits and section #) 2. Attend First Internship Class (obtain course syllabus and schedule oral presentation)

3. Review Course Syllabus

4. Review The Health and Kinesiology Practicum/Internship Handbook and other course materials

5. Investigate Sites and provide Site Supervisor with your Resume and a Record of Courses Completed

6. Obtain permission from Site Supervisor to seek site approval from College Supervisor

7. Obtain approval of Initial Site Description from College Supervisor

8. Set up initial meeting with yourself, College Supervisor and Site Supervisor.

9. Provide Internship Site Supervisor with a copy of the The Health and Kinesiology Practicum/Internship

Handbook, and the Site Supervisor Evaluation Form

10. Return the signed Service Learning Agreement (if required)to College Supervisor

11. Get fingerprinted (if this is required by the site) and see that documents are sent to the Site and College Supervisor

DURING THE INTERNSHIP

1. Complete Time Log daily

2. Complete a Safety/Liability Checklist

3. Complete the Site Supervisor/Student Meeting Notes

4. Attend Small Group Meetings (or alternative if applicable)

5. Obtain completed Progress Report Form from Supervisor and give it to the

College Supervisor

6. Meet with College Supervisor

7. Set up and attend final meeting with College Supervisor and Site Supervisor

8. Obtain completed Site Supervisor Evaluation Form

AFTER THE INTERNSHIP

1. Submit Internship Portfolio including:

a. Checklist of Responsibilities

b. Resume

c. Initial Site Description

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d. Time Log

e. Internship Reflection

f. Safety Checklist

g. Site Supervisors Final Evaluation

h. Feedback about the Internship

2. Complete an Oral Presentation

DESCRIPTION of ASSIGNMENTS

1. Internship site Selection (and check the number of credits in which you are enrolled)

Many students know where and with whom they would like to gain experience in the field. Settings may

include day care centers, recreation programs, schools, public health and community agency programs,

nursing homes, etc. Preferably select a service activity that engages you with the population with which

you eventually would like to work, and/or addresses a health/sport issue in which you are particularly

interested.

You will need to get permission to do your internship with someone working at the site. This person will

be called your Site Supervisor. It will be your responsibility to provide your Site Supervisor with a copy of

your resume and a copy of your current degree program plan indicating the courses you have passed so far.

ALL SITES MUST BE APPROVED BY ME, YOUR COLLEGE SUPERVISOR.

2. Initial Site Description form (see form)

This assignment is due no later than two weeks after the semester begins or after you add this course. The

instructor will review your site description and provide approval. Keep a copy of the completed Initial Site

Description form because you will include it in your portfolio.

You may also be asked to have your Site Supervisor complete a Service Learning

Agreement. Your College Supervisor will provide this form if it is needed at your particular site.

3. Supervisor and Student Meeting Notes (see form)

During the first few days of your experience in the field, you and your Site Supervisor will need to discuss

item that will be important to your success. Please use the Supervisor and Student Meeting Notes form to

guide your discussion, but there may be other items about which your Supervisor would like you to know.

4. Evaluations by Your Site Supervisor (see Evaluation forms)

You will be given a Progress Report form and a Final KIN 494 Site Supervisor Evaluation form to be filled

out by your Site Supervisor. It will be your responsibility to obtain the form, give it to your Site

Supervisor, get the completed form back by the due date and place a copy of it in your portfolio. (The

original evaluation should by kept for you to use in your Kinesiology Senior Portfolio.) You will not

receive full credit if this evaluation is late. If you do not receive a satisfactory evaluation, I may decide to

give you an Incomplete or failing grade in the class.

5. Internship Portfolio

When you complete your Internship, you will submit to me an Internship Portfolio. The portfolio must be

neat and organized and contain the items listed below and in the summary chart under the Grading section

of this syllabus.

You are responsible for making your own copy of all assignments and supervisor evaluations. You should

keep the original copy of your supervisor evaluations and give me a copy. I will not return your work

unless it is something like pictures, handouts, posters, or other forms of evidence. You will be expected to

include items from your Internship Portfolio, including your supervisor evaluations, in the Kinesiology

program exit portfolio that will be part of KIN 499, Senior Seminar and Research/Project.)

a. Checklist of Responsibilities (See Form)

The Checklist of Responsibilities form is designed to guide you through the steps needed to

successful complete your Internship.

b. Resume

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If you have not attended the resume building session in KIN 260, you will be responsible for

attending a resume workshop put on by the Career Center. Once you have attended one of these

sessions you will need to go have your draft resume reviewed at the Career Center. They will not

review your resume until you have attended a resume workshop with them.

c. Internship Reflection (see assignment handout)

You will be given a handout with questions that will help you reflect on your experience during

the semester. Most of the questions should be answered after you complete your on-site internship

work.

d. Safety and Liability Checklist (see form)

During your internship you should be fully aware of your responsibility to create a safe

environment of all clients, participants, athletes, etc. Please complete the Safety and Liability

Checklist at least one time during your field experience.

e. Feedback About the Internship (see form)

This assignment is designed to help your LCSC faculty improve internship experiences in the

future.

f. Time Log (see form)

You will need to record your time out in the field on the form provided. You will receive 1 credit

for each 45 hours of effort toward an internship experience. For each credit earned you will need

to document 30 hours in direct service to or in actual contact with the individual or population.

The rest of the 15 hours must be spent researching your assignments, meeting individually with

me, completing your portfolio, preparing for your oral presentation, and attending class.

6. Oral Presentation

Before the end of the semester you will do an oral presentation about your Internship. To earn an “A” in

the class you must do an oral presentation. Include in your presentation anything you believe would be

interesting to the class.

You must at least provide a summary of the experience that includes the following:

! Describe what you learned about this health/sport issue as it relates to the group with whom you

worked.

! Describe what you believe the children/adolescents/adults you worked with got out of the

experience of working with you and the service you provided.

! Describe what you learned about yourself and what you gained as a result of delivering this

service.

You may showcase your internship experience using a variety of formats including:

• Pictorial - photo essays with captions, poster, billboard/bulletin board, illustration or power point

presentation

• Verbal presentation - poetry, story telling, verbal histories or case studies

• Dramatization: creative imagery, rap song, puppet show, or dance

• Video Production: scripted or selected event highlights

• Skill Demonstration: demonstrate a skill(s) you learned from your internship experience

7. Class/Meeting Attendance

The course is designed so that most of you will be able to attend the class. I have built some

flexible times into the schedule so I can better accommodate your schedules. You will earn credit for

attending a small group meeting, at least two individual meetings with me and at least one class period of

oral presentations.

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In addition, you and I will meet with your Site Supervisor(s) immediately after you start your internship

and also for an oral evaluation of your performance. In some cases, I will come to observe you at your

Internship site; in other cases I will conduct my communications and evaluations over the phone. It is your

responsibility to set up these meetings and observations. E-mail is the best way to communicate

with me.

GRADING The following chart summarizes the class assignments.

Assignment Who Completes % of

grade

Date Due

Initial Site Description Student 2 2 weeks after

adding the

course

Service Learning Agreement Student, Site Supervisor,

College Supervisor

Depends

on site

2 weeks after

adding the

course

Supervisor & Student Meeting Notes Site Supervisor & Student 5 2 weeks after

field experience

begins

Progress Report Site Supervisor 5

Oral Presentation Rubric College Supervisor 10 Completed

At the

Presentation

Class and Meeting Attendance Student 10

Portfolio - Submitted on Time and

including the items below:

Student 2

Checklist of Responsibilities Student 2

Resume Student 2

Safety/Liability Checklist Student 2

Site Supervisor and Student

Meeting Notes

Student Listed

above

Internship Reflection Student 15

Feedback about the

Internship/Practicum

Student 5

Time Log Student and Site

Supervisor

30

Site Supervisor’s

Evaluation Form

Site Supervisor 10

TOTAL 100%

Your grade will be calculated according to the following scale:

Percentages:

93 -100% =A Exemplary

90 -92.9% =A-

88.0 -89.9% =B+ Proficient

83.0 -87.9% =B

80.0 -82.9% =B-

77.0 -79.9% =C+

74.0 -76.9% =C Good, Average

71.0 -73.9% =C-

68.0 -70.9% =D Below Average, Unsatisfactory

0 -67.9% =F Failing, No academic Credit

Please note that you can pass the class without doing an oral presentation. However, to earn a degree, you

must include in your exit portfolio an evaluation of your oral internship presentation and a satisfactory

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evaluation by an internship supervisor. To earn an “A” in this class you must complete an oral

presentation, even if you are only signed up for one credit.

NOTE: The following statements must be included on all syllabi at LCSC

FERPA Statement:

The Family Educational Rights and Privacy Act (FERPA) is a federal law designed to protect the

privacy of student education records and is enforced by the U.S. Department of Education. In

essence, the act states that 1) students must be permitted to inspect their own “education records”

and 2) “school officials” may not disclose personally identifiable information about a student

without written permission from the student. For further information on FERPA and LCSC’s

directory information policy, visit www.lcsc.edu/registrar or call 208-792-2223.

Disability Services:

“If you need course adaptations or accommodations because of a disability, if you have

emergency medical information to share with me, or if you need special arrangements in case the

building must be evacuated, please make an appointment to talk with me.

Judicial Affairs:

“Cheating or plagiarism in any form is unacceptable. The College functions to promote the

cognitive and psychosocial development of all students. Therefore, all work submitted by a

student must represent his/her own ideas, concepts and current understanding.” If you suspect a

student has committed an act of academic dishonesty, document the incident and notify the

Judicial Affairs Officer in Reid Hall 111, phone 2211.

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SYLLABUS (example)

DATE:

COURSE NUMBER AND TITLE: HLTH/KIN 495 PRACTICUM

CREDIT HOURS: 1-12 credits

ONE CREDIT = 45 HOURS of WORK

INSTRUCTOR:

OFFICE:

OFFICE HOURS:

PHONE:

E-MAIL

COURSE DESCRIPTION This course is designed to deliver health, physical education or athletic-related service to a school, agency or

organization that works with an age group of your choice i.e. children, adolescents, adults or older adults. This

option must involve direct service and must be health or physical education or athletic related.

The course will involve structured opportunities intentionally designed to promote student learning and

development. Therefore, it is highly recommended that you have finished courses related to the service you will be

providing at your internship site. If you have not done the appropriate coursework, your instructor may ask you to

enroll in a 295 or 495 Practicum instead of the 494 Internship.

COURSE OUTCOMES /PERFORMANCES It will be your responsibility to read and understand this syllabus and to note any changes in the course if they occur

during the semester; please feel free to ask questions. In addition, you must keep your own copy (a duplicate) of

each assignment.

To earn an “A” in this class you must satisfactorily complete the following by the end of this Internship:

PRIOR TO FIELD EXPERIENCE

1. Enroll in Internship Course (check # of credits and section #) 2. Attend First Internship Class (obtain course syllabus and schedule oral presentation)

3. Review Course Syllabus

4. Review The Health and Kinesiology Practicum/Internship Handbook and other course materials

5. Investigate Sites and provide Site Supervisor with your Resume and a Record of Courses Completed

6. Obtain permission from Site Supervisor to seek site approval from College Supervisor

7. Obtain approval of Initial Site Description from College Supervisor

8. Set up initial meeting with yourself, College Supervisor and Site Supervisor.

9. Provide Internship Site Supervisor with a copy of the The Health and Kinesiology Practicum/Internship

Handbook, and the Site Supervisor Evaluation Form

10. Return the signed Service Learning Agreement (if required)to College Supervisor

11. Get fingerprinted (if this is required by the site) and see that documents are sent to the Site and College Supervisor

DURING THE FIELD EXPERIENCE

12. Complete Time Log daily

13. Complete Site Supervisor/Student Meeting Notes

14. Meet with College Supervisor

15. Set up and attend final meeting with College Supervisor and Site Supervisor

16. Obtain completed Site Supervisor Evaluation Form

AFTER THE FIELD EXPERIENCE

17. Submit Internship Portfolio including:

a. Checklist of Responsibilities

b. Resume

c. Initial Site Description

d. Time Log

e. Site Supervisors Final Evaluation

DESCRIPTION of ASSIGNMENTS 1. Practicum site Selection (and check the number of credits in which you are enrolled)

Many students know where and with whom they would like to gain experience in the field. Settings may

include day care centers, recreation programs, schools, public health and community agency programs,

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nursing homes etc. Preferably, select a service activity that engages you with the population with which

you eventually would like to work, and/or addresses a health/sport issue in which you are particularly

interested.

You will need to get permission to do your practicum with someone working at the site. This person will

be called your Site Supervisor. It will be your responsibility to provide your Site Supervisor with a copy of

your resume and a copy of your current degree program plan indicating the courses your have passed so far.

ALL SITES MUST BE APPROVED BY ME, YOUR COLLEGE SUPERVISOR.

2. Initial Site Description form (see form)

This assignment is due no later than two weeks after the semester begins or after you add this course. The

instructor will review your site description and provide approval. Keep a copy of the completed Initial Site

Description form because you will include it in your portfolio.

You may also be asked to have your Site Supervisor complete a Service Learning

Agreement. Your College Supervisor will provide this form if it is needed at your particular site.

3. Supervisor and Student Meeting Notes (see form)

During the first few days of your experience in the field, you and your Site Supervisor will need to discuss

items that will be important to your success. Please use the Supervisor and Student Meeting Notes form to

guide your discussion, but there may be other items about which your Supervisor would like you to know.

4. Evaluations by Your Site Supervisor (see Evaluation forms)

You will be given a Progress Report form and a Final KIN 494 Site Supervisor Evaluation form to be filled

out by your Site Supervisor. It will be your responsibility to obtain the form, give it to your Site

Supervisor, get the completed form back by the due date and place a copy of it in your portfolio. (The

original evaluation should be kept for you to use in your Kinesiology Senior Portfolio.) You will not

receive full credit if this evaluation is late. If you do not receive a satisfactory evaluation, I may decide to

give you an Incomplete or failing grade in the class.

5. Practicum Portfolio

When you complete your Internship, you will submit to me a Practicum Portfolio. The portfolio must be

neat and organized and contain the items listed below and in the summary chart under the Grading section

of this syllabus.

You are responsible for making your own copy of all assignments and supervisor evaluations. You should

keep the original copy of your supervisor evaluations and give me a copy. I will not return your work

unless it is something like pictures, handouts, posters, or other forms of evidence. You will be expected to

include items from your Portfolio, including your supervisor evaluations, in the Kinesiology program exit

portfolio that will be part of KIN 499, Senior Seminar and Research/Project.)

a. Checklist of Responsibilities (See Form)

The Checklist of Responsibilities form is designed to guide you through the steps needed to

successful complete your Field Experience.

b. Resume

If you have not attended the resume building session in KIN 260, you will be responsible for

attending a resume workshop put on by the Career Center. Once you have attended one of these

sessions you will need to go have your draft resume reviewed at the Career Center. They will not

review your resume until you have attended a resume workshop with them.

c. Time Log (see form)

You will need to record your time out in the field on the form provided. You will receive 1 credit

for each 45 hours of effort toward your practicum. For each credit earned you will need to

document 40 hours in direct service to or in actual contact with the individual or population. The

rest of the 5 hours must be spent researching your assignments, meeting individually with me,

completing your portfolio, and/or attending class.

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6. Class/Meeting Attendance

Although you will not be required to attend class, I have included the class schedule for the students

enrolled in internship in case you are interested in attending.

In addition, you and I will meet with your Site Supervisor(s) immediately after you start your internship

and also for an oral evaluation of your performance. In some cases, I will come to observe you at your

Internship site; in other cases I will conduct my communications and evaluations over the phone. It is your

responsibility to set up these meetings and observations. E-mail is the best way to communicate with me.

GRADING

The following chart summarizes the class assignments.

Assignment Who Completes % of

grade

Date Due

Initial Site Description Student 2 2 weeks after

adding the course

Service Learning Agreement Student, Site Supervisor,

College Supervisor

Depends

on site

2 weeks after

adding the course

Supervisor & Student Meeting

Notes

Site Supervisor &

Student

5 2 weeks after

field experience

begins

Progress Report Site Supervisor 2

Communication/meetings with

College Supervisor

10

Portfolio - Submitted on Time

and including the items below:

Student 2

Checklist of Responsibilities Student 2

Resume Student 2

Site Supervisor and Student

Meeting Notes

Student Listed

above

Time Log Student and Site

Supervisor

65

Site Supervisor’s

Evaluation Form

Site Supervisor 10

TOTAL 100%

Your grade will be calculated according to the following scale:

Percentages:

93 -100% =A Exemplary

90 -92.9% =A-

88.0 -89.9% =B+ Proficient

83.0 -87.9% =B

80.0 -82.9% =B-

77.0 -79.9% =C+

74.0 -76.9% =C Good, Average

71.0 -73.9% =C-

68.0 -70.9% =D Below Average, Unsatisfactory

0 -67.9% =F Failing, No academic Credit

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NOTE: The following statements must be included on all syllabi at LCSC

FERPA Statement:

The Family Educational Rights and Privacy Act (FERPA) is a federal law designed to protect the

privacy of student education records and is enforced by the U.S. Department of Education. In

essence, the act states that 1) students must be permitted to inspect their own “education records”

and 2) “school officials” may not disclose personally identifiable information about a student

without written permission from the student. For further information on FERPA and LCSC’s

directory information policy, visit www.lcsc.edu/registrar or call 208-792-2223.

Disability Services:

“If you need course adaptations or accommodations because of a disability, if you have

emergency medical information to share with me, or if you need special arrangements in case the

building must be evacuated, please make an appointment to talk with me.

Judicial Affairs:

“Cheating or plagiarism in any form is unacceptable. The College functions to promote the

cognitive and psychosocial development of all students. Therefore, all work submitted by a

student must represent his/her own ideas, concepts and current understanding.” If you suspect a

student has committed an act of academic dishonesty, document the incident and notify the

Judicial Affairs Officer in Reid Hall 111, phone 2211.

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Appendix B

Forms

• Student Forms Checklist of Responsibilities KIN 495

Checklist of Responsibilities KIN 494

Initial Site Description

Site Supervisor and Student Meeting Notes

Safety and Liability Checklist

Internship Reflection

Time Log

Feedback about the Internship

Confidentiality Policy and Agreement

• Site Supervisor Forms Midterm Progress Evaluation

Practicum/Internship Evaluation Form

Service Learning Agreement

• College Supervisor Forms Oral Presentation Rubric

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CHECKLIST OF RESPONSIBILITIES

KIN/HLTH 494 Internship

Name:

Internship Site:

Site Supervisor:

RESPONSIBILITIES PRIOR TO INTERNSHIP

Enroll in Internship Course (check # of credits and section #)

Attend First Internship Class (obtain course syllabus and schedule oral

presentation)

Review Course Syllabus

Review The Health and Kinesiology Practicum/Internship Handbook and

other course materials

Investigate Sites and provide Site Supervisor with your Resume and

And a Record of Courses Completed

Obtain permission from Site Supervisor to seek site approval from

College Supervisor. Submit Initial Site Description to College Supervisor

Obtain approval of Initial Site Description from College Supervisor

Set up initial meeting with yourself, College Supervisor and Site Supervisor.

Provide Internship Site Supervisor with a copy of the The Health and

Kinesiology Practicum/Internship Handbook, The Site Contract, and the Site Supervisor Evaluation Form

Return the signed Service Learning Agreement (if required) to College Supervisor Get fingerprinted

(if this is required by the site) and see that documents are sent to the Site and College Supervisor

RESPONSIBILITIES DURING THE INTERNSHIP

Complete Time Log daily

Complete Safety/Liability Checklist

Complete Site Supervisor/Student Meeting Notes

Attend a Small Group Meetings (or alternative if applicable)

Meet with College Supervisor

Obtain completed Progress Report Form from Supervisor and give it to the

College Supervisor

Set up and attend final meeting with College Supervisor and Site

Supervisor

Obtain completed Site Supervisor Evaluation Form

RESPONSIBILITIES AFTER THE INTERNSHIP

Submit Internship Portfolio including:

Checklist of Responsibilities

Resume

Initial Site Description

Site Supervisor and Student Meeting Notes

Time Log

Safety Checklist

Internship Reflection

Site Supervisor’s Final Evaluation

Feedback about the Internship

Complete an Oral Presentation

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CHECKLIST OF RESPONSIBILITIES

KIN/HLTH 495 Practicum

Name:

Practicum Site:

Site Supervisor:

RESPONSIBILITIES PRIOR TO PRACTICUM

Enroll in Practicum Course (check # of credits and section #)

Attend First Class (obtain course syllabus)

Review Course Syllabus

Review The Health and Kinesiology Practicum/Internship Handbook and

other course materials

Investigate Sites and provide Site Supervisor with your Resume and a

Record of Courses Completed

Obtain permission from Site Supervisor to seek site approval from

College Supervisor. Submit Initial Site Description to College Supervisor

Obtain approval of Initial Site Description from College Supervisor

Set up initial meeting with yourself, College Supervisor and Site Supervisor.

Provide Internship Site Supervisor with a copy of the The Health and

Kinesiology Practicum/Internship Handbook, The Site Contract, and the Site Supervisor Evaluation Form

Return the signed Service Learning Agreement (if required) to College Supervisor Get fingerprinted

(if this is required by the site) and see that documents are sent to the Site and College Supervisor

RESPONSIBILITIES DURING THE PRACTICUM

Complete Time Log daily

Complete Site Supervisor/Student Meeting Notes

Meet with College Supervisor

Set up and attend final meeting with College Supervisor and Site

Supervisor

Obtain completed Progress Report Form from Supervisor and give it to the

College Supervisor

Obtain completed Site Supervisor Evaluation Form

RESPONSIBILITIES AFTER THE PRACTICUM

Submit Notebook of Assignments including:

Checklist of Responsibilities

Resume

Initial Site Description

Time Log

Site Supervisors Final Evaluation

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Initial Site Description

Intern Information

Name:

Local Address:

City/Zip:

Phone:

E-mail:

Permanent Address:

City/Zip:

Course Information: (please check to make sure you have signed up for the correct section and

number of credits)

Number of Credits:

Course Number and section:

Course Title:

Site Information:

Name of Site:

Site Address:

Site Phone:

Name of Your Site Supervisor:

Phone:

E-mail:

Best times & dates to contact:

Reasons for selecting this site:

Dates on Site (approximate)

Start Date:

End Date:

Planned Activities/Responsibilities:

Proposed Work Hours and Days:

PLEASE GIVE THIS FORM TO YOUR COLLEGE SUPERVISOR BEFORE YOU START YOUR

INTERNSHIP

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Site Supervisor and Student Meeting Notes

PART A: Checklist of Essential Information Discussed

Directions: You and your Site Supervisor will be meeting to discuss important information that will help your

internship be successful for everyone involved. To help guide this discussion I would like you to check all items below

that you and your Site Supervisor discuss.

Agency protocol in common situations:

Tardiness or absence from work

Dress codes

Essential paperwork, planning documents or forms to complete

Keys and security issues

Facility Maintenance

Storage of documents, equipment, etc.

Phone usage

Reporting concerns, problems, changes

Giving advise to clients/participants

Physical contact with clients/participants

Dealing with disruptive behavior

Issues related to client/participant confidentiality

Safety considerations

Medical conditions and medications of clients/participants

Medical Clearance for participant participation

Injury Reports and Procedures

Training sessions needed for personnel

Informing participants about risks involved in activities

Informing participants about medical signs/symptoms

Administering first aid and medicines

Emergency procedures

Evacuation during emergencies

Procedures for Fire, Terrorism, Intruders, etc.

Course Related Information

Class assignments

Hours of Service

Evaluation and Grading

Internship Handbook

Course syllabus

Your Resume and qualifications

PART B: Internship Job Description

Directions: With the help of your Site Supervisor, please develop an Internship (Job) Description. What is your Role?

Do you have a job title? Describe or list your responsibilities.

Intern Signature:

Site Supervisor Signature:

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Safety and Liability Checklist

Directions: Use the checklist below to evaluate your readiness to coach/instructor/administer the activities you have been assigned during your

internship

Your Internship Role/Title:

Internship Site:

Safety Procedures Yes No N/A Comments

Do you have the necessary skills and knowledge required

for your internship role?

Are you first aid and CPR certified?

Do you have well thought out plans for the activities you

will be completing?

Are your plans based on sound educational principles and

best practices?

Do your plans fit logically into the agency mission and

long term plans?

Have you assessed the client/participant abilities? Is each

individual developmentally ready for each activity?

Do the activities plan for individual differences among

participants?

Have the participants been grouped for safety concerns

according to age, ability level, size?

Have the participants been warned of the dangers inherent

in the activity?

Have the participants been given the agency and activity

rules?

Do the participants understand your method for stopping

activity in emergency situations?

Have you positioned yourself to properly supervise all

activity?

Have the participants been given proper demonstrations

and directions for performance of the skills and activities?

Has the equipment been inspected for safety?

Are the playing areas, dressing rooms, hallways, etc safe?

Are you and the participants dressed for safety?

Are the safety and emergency procedures written and

known by all participants?

Have you communicated all of your plans with your

supervisor?

Name: Date:

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Internship Reflection Name:

Internship Site:

Directions: After you have completed your internship field work, please reflect on what you have learned and how you are

different as a result of completing this internship. Your reflection must by typed. Include this form in you final Internship

Portfolio.

1. Describe the individuals or groups to whom your agency provided service. (age, gender, ethnicity, socioeconomic

status, educational level, etc.)

2. What service does your agency provide?

3. What did you actually do during the internship?

4. How successful do you think you were at completing your internship role? What difference did you make to the

agency?

5. What was the most meaningful experience associated with your Internship? Please explain.

6. What was your most frustrating or least valuable experience? Please explain.

7. What could have been done to prevent, alleviate or change the situation?

8. What did you learn that you did not know before? (new knowledge, new skills, new ways of looking at situations or

people)

9. How has this internship helped you prepare to meet your career goals?

10. How have you changed personally and professionally?

11. Would you consider seeking employment in this field after graduation? Why or why not?

12. Develop a mission statement for your site location if one is not available at your site. Also include three mission

statements from facilities that are similar to your internship site. You may use the mission statements from other local

businesses or from a WEB search.

13. Research career opportunities for jobs similar to those at your internship site. Answer the following related questions:

a. List the job titles (or professional roles) and the responsibilities of individuals at worksites similar to yours.

b. What are the predicted salary ranges for each of the roles you have listed above?

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Page #:

Time Log Health and Kinesiology Practicum/Internship

Date Time In Time Out # hours

worked

List of work/ accomplishments

Intern Signature:

Site Supervisor Signature:

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Feedback about the Internship

KINESIOLOGY/HEALTH 494

Name of Site:

Directions: Please circle the 5 courses that helped prepare you the most for this practicum or internship?

KIN 241 Sport Officiating

KIN 2... Techniques of Coaching

KIN 2... Techniques of Coaching

KIN 260 Survey of Human Movement

KIN 263 Skill/Analysis: Tennis & Golf

KIN 264 Skill/Analysis: Basketball & Soccer

KIN 266 Skill/Analysis: Volleyball & Softball

KIN 272 Fitness and Wellness

KIN 352 Youth Sports & Recreation

KIN 355 Strategies for Teaching Physical Activity

KIN 348 Sports Medicine

KIN 362 Biomechanics

KIN 363 Exercise Physiology

KIN 370 Motor Learning

KIN 381 Tests and Measurements

KIN 410 Sport Psychology

KIN 420 Social Cultural Aspects of Sport

KIN 425 Moral Reasoning in Sport

KIN 433 Balance and Mobility

KIN 434 Exercise Prescription

KIN 435 Aging and Physical Activity

KIN 434 Exercise Prescription

KIN 467 Phys Act/Rec/Special Needs

KIN 472 Outdoor Education

KIN 486 Organization & Administration HPER

KIN 487 Sport Administration

KIN 488 Sport Facilities and Event Management

HLTH 288 AED/CPR/First Aid

HLTH 346 Human Sexuality

HLTH 347 Stress Management

HLTH 452 Health Promotion and Wellness Coaching

HLTH 353 Nutrition

HLTH 352 Technologies for Wellness Professionals

HLTH 456 Drugs and the Athlete

HLTH 457 Drugs and Society

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Directions: Please help us improve the courses and experiences we offer our students by answering the following

questions:

1. Would you recommend this site for LCSC Interns in the future? Please explain.

2. How would you rate your experience with this agency as a learning experience?

Excellent Good Average Fair Poor

Explain why you indicate the above rating:

3. Did you feel that your duties were a vital part of the agency’s function? Were you given an adequate level

of responsibility? Why or why not?

4. Did your agency supervisor lend assistance during the field experience? Explain.

5. What were the most valuable assets of this placement experience?

6. What were the least valuable aspects of this experience if applicable?

7. List what you believe are the agency's strengths and weaknesses.

8. List what you believe are the supervisor's strengths and weaknesses.

9. What suggestions do you have for making this Practicum or Internship better in the future.

10. What additional internship experiences would be helpful to you as you prepare for graduate school or to

enter the workforce after graduation?

Your Name:

Date:

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CONFIDENTIALITY POLICY

It is the policy of the Health and Kinesiology Program that all

Practicum Students and Interns sign a statement regarding the

confidentiality of agency clients/program participants. This policy is for

the protection of the individuals involved. In signing this form the

student states that she/he will not disclose any names or information

regarding agency clients/program participants to peers, friends, or

relatives.

CONFIDENTIALITY AGREEMENT

I agree to protect the confidentiality of the agency clients/program

participants in all situations.

_________

Student /date

College Supervisor/date

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Directions for Site Supervisors:

Please complete this form after the Intern/Practicum Student has completed approximately half of hours they are planning to spend with you.

Please share the completed form with the LCSC student. If you would rather mail the evaluation form, please make sure I receive it in time to

give the student a grade. Please feel free to call or write me. My address follows:

Dr. Betsy Van Clief, Health and Kinesiology Coordinator

Lewis Clark State College

Lewiston, Idaho 83501

208-792-2277 ([email protected])

Please respond to each of the following questions regarding the services conducted by the LCSC student. CIRCLE the number that best

represents your evaluation using the following scale:

5=EXCEPTIONAL 4=Good 3= Satisfactory 2=Just adequate 1= UNSATISFACTORY

The LCSC student:

5 4 3 2 1 Keeps appointments and is on time for work

5 4 3 2 1 Completes all projects and assignments on time

5 4 3 2 1 Maintains a professional demeanor

5 4 3 2 1 Demonstrates effective work habits and planning skills

5 4 3 2 1 Demonstrates education and experience to complete tasks assigned

5 4 3 2 1 Interacts well with co-workers and supervisors

5 4 3 2 1 Interacts well with participants, parents and/or community

5 4 3 2 1 Maintains confidentiality

5 4 3 2 1 Communicates effectively with supervisor and clients

5 4 3 2 1 Uses effective teaching/coaching/communication methods (such as drills, posters,

transparencies, methods etc.)

5 4 3 2 1 Uses effective management and organizational skills

5 4 3 2 1 Reacts positively to constructive feedback

How can the student improve his/her performance in this role?

Additional comments about the student:

Signature of Site Supervisor Date

MIDTERM PROGRESS REPORT

HLTH/KIN/REC 495/494 PRACTICUM/INTERNSHIP

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Directions for Site Supervisors:

Please complete this form and give it to the LCSC student after completion of all hours of work. If you would rather

mail the evaluation form, please make sure I receive it in time to give the student a grade. Please feel free to call or

write me. My address follows: Dr. Betsy Van Clief, Health and Kinesiology Coordinator

Lewis Clark State College

Lewiston, Idaho 83501

208-792-2277 ([email protected])

PART I: General Information

Name of LCSC Student:

Your Name:

Your Title:

Service Site:

Address:

Telephone: Best Times/Days to contact

Email:

Number of Hours spent on site by the Intern this semester:

PART II: Questions about LCSC's PRACTICUM/INTERNSHIP Program

(Feel free to write on the back of this page)

A. Was having an LCSC student of benefit to your program?

Please explain some of the benefits.

_____________________________________________________________________

_____________________________________________________________________

B. Were there disadvantages to having the student working in your program?

If so, please explain.

_____________________________________________________________________

_____________________________________________________________________

C. Would you like to have LCSC students participate again?

_____ Yes _____ No Please explain.

__________________________________________________________________

D. In general, were you pleased with the services provided by the LCSC student?

______ Pleased ______ Somewhat pleased ______ Very displeased

FINAL EVALUATION FORM

HLTH/KIN/REC 495/494 PRACTICUM/INTERNSHIP

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Final Evaluation Form – Page 2

PART III: Evaluation of Your LCSC Student

Directions: Please respond to each of the following questions regarding the services conducted by the LCSC student.

CIRCLE the number that best represents your evaluation using the following scale:

5=Exceptional 4=Good 3=Satisfactory 2=Just adequate 1=UNSATISFACTORY

5 4 3 2 1 Kept appointments and was on time for work

5 4 3 2 1 Completed all projects and assignments on time

5 4 3 2 1 Maintained a professional demeanor

5 4 3 2 1 Demonstrated effective work habits and planning skills

5 4 3 2 1 Demonstrates education and experience to complete tasks assigned

5 4 3 2 1 Interacted well with co-workers and supervisors

5 4 3 2 1 Interacted well with participants, parents and/or community

5 4 3 2 1 Maintains confidentiality

5 4 3 2 1 Communicated effectively with supervisor and clients

5 4 3 2 1 Used effective teaching/coaching/communication methods (such as drills, posters,

transparencies, methods etc.)

5 4 3 2 1 Used effective management and organizational skills

5 4 3 2 1 Reacted positively to constructive feedback

5 4 3 2 1 Met my expectations.

List some of the student’s best characteristics:

How can the student improve his/her performance in this role?

In your opinion, how well is this individual suited for employment at a worksite similar to your agency? Please feel

free to comment.

Additional comments about the student:

Signature of Site Supervisor Date

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(Example)

LCSC KINESIOLOGY & HEALTH PROGRAM

KIN/HLTH/REC 494 Internships and KIN/HLTH/REC 495 Practicum

SERVICE-LEARNING AGREEMENT

(Note: All sites do not require a service learning agreement)

This Agreement confirms that the service-learning student and (Agency) supervisor agree to the

expectations outlined in this agreement and that they intend to accomplish the following goals:

Learning Goals:

This experience is designed to introduce students to health, physical education or athletic-related services in schools, agencies, organization or

businesses. Students may work with any age group of choice, i.e. children, adolescents, adults or older adults. One to 12 LCSC credits maybe

taken during a semester, however, each credit involves 45 hours of work.

Service Goals:

This experience is intended to provide the agency with:

Energetic and enthusiastic volunteers

Increased visibility to the campus and community

An enhanced relationship with Lewis-Clark State College

A reciprocal learning partnership with LCSC students and faculty

Expectations:

The Student will:

1. Accomplish assignments that have been agreed upon and meet the needs of the agency and its clients.

2. Be responsible for the agreed service hours, and call ahead if going to be late or unable to attend a scheduled shift.

3. Follow all policies of the site, including health and safety precautions and confidentiality.

4. Not work in a room alone with a client, or transport a client, unless specifically screened and cleared to do so by the agency.

5. Notify the supervisor and/or activity director of any problems, concerns, or changes.

6. Keep a record of student hours, and present them to the agency if needed.

LCSC will:

1. Require students and assigned faculty to conform to the policies and procedures of the Agency.

2. Ensure that assigned faculty are available by telephone/beeper at all times when the students are in the agency.

3. Ensure that students and assigned faculty are informed of, and comply with, all applicable agency rules and regulations.

The Community/Agency Site Supervisor will:

1. Involve the student in assignments that support the learning goals, insofar as possible.

2. Provide orientation and training.

3. Have clear risk management, an emergency plan and personnel policies and procedures in place, and include these in student

training.

4. Provide a supervisor to guide and evaluate the student. The supervisor will be present at all times.

5. Clarify procedures for the student to report problems, to get assistance, and to make suggestions.

6. Complete an evaluation form, if provided.

7. Notify the student and/or the activity director of any problems, concerns, or changes.

Relationship of Parties:

1. It is agreed that while in the laboratory setting of the Agency the Kinesiology and Health student is considered an authorized

volunteer and as such is insured by virtue of the additional interest endorsement policy provided by the Agency. In addition,

Kinesiology and Health students will be covered by a mandatory liability insurance policy required by Lewis-Clark State

College.

2. The College and the student agree to not use or disclose protected health information other than as permitted or required by this

Agreement or as required by law. The College and the student agree to use appropriate safeguards to prevent use or disclosure

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of the protected health information other than as provided by this Agreement and the Health Insurance Portability and

Accountability Act (HIPPA).

3. This agreement shall be in effect for one (1) year from the Effective Date and shall be renewed automatically each year unless

terminated by either party. Either party may terminate this Agreement without cause upon one (1) year’s written notice. This

agreement may be amended at any time by mutual agreement.

LEWIS-CLARK STATE COLLEGE AGENCY

Appropriate College Administrator Site Supervisor (print)

Title Title

Phone/ email Site Supervisor’s Contact phone/e-mail

Signature Date Site Supervisor’s Signature Date

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35

INTERN: TODAY’S DATE:

INTERNSHIP SITE:

INDICATOR PTS

EXCEPTIONAL

13-20 pts

PROFICIENT

8-12 pts

DEVELOPING

1-7 pts

UNACCEPTABLE

0 pts

What you learned

Clear, accurate

description of the

skills and knowledge

you learned

Understandable

description of the skills

and knowledge you

learned

Unclear and/or

inaccurate description of

the skills and

knowledge you learned

Skills and knowledge

learned by the Intern

was not presented

What your client

learned

Clear, very accurate

description of the

skills and knowledge

your client learned

Understandable and

accurate description of

the skills and knowledge

your client learned

Unclear and/or

inaccurate description of

the skills and

knowledge your client

learned

Skills and knowledge

learned by the client

was not addressed

in the presentation

What you learned

about yourself

Clear, very accurate

description of what

you learned about

yourself

Understandable and

accurate description of

what you learned about

yourself

Unclear and/or

inaccurate description of

what you learned about

yourself

What the Intern learned

about him/herself was

not presented

Visual or verbal

showcasing

High quality visual or

verbal showcasing

Some visual or verbal

showcasing

Poor quality visual or

verbal showcasing

Visual or verbal

showcasing was not

used to enhance the

presentation

Clarity of

presentation

evidence of

organization&

planning.

Easy to understand

and very well

organized

Understandable and well

organized

Presentation was

unclear and not

organized

There was no evidence

of prior planning for the

presentation.

TOTALS

Directions: Circle the type of showcasing used in the presentation

Pictorial: photo essays with captions, poster, bulletin board, illustration or power point

Verbal presentation: poetry, story telling, verbal histories or case studies

Dramatization: creative imagery, rap song, puppet show, or dance

Video Production: scripted or selected event highlights

Skill Demonstration: demonstrated skill(s) learned from the internship experience

Other: ______________________________________________________________

Evaluator:

ORAL PRESENTATION EVALUATION FORM

KIN/HLTH/REC 494 INTERNSHIPS

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Appendix C

o Internship Sites

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37

INTERNSHIP and PRACTICUM SITES

(partial listing)

ATHLETIC ADMINISTRATION/SPORT MANAGEMENT/COACHING

Boys and Girls Club

1021 Burrell

Lewiston, ID 83501

(208) 746-2301

Lewis-Clark State College

Athletic Director

500 8th Ave.

Lewiston, ID 83501

Asotin-Anatone Schools:

Athletic Director

Jr. and Sr. High School

214 2nd St.

Asotin, WA 99402

(509) 243-4151

Clarkston Middle & High School:

Lincoln Middle School

1945 4th Ave.

Clarkston, WA 99403

(509) 758-5506

Clarkston High School

401 Chestnut

Clarkston, WA 99403

(509) 758-5591

Whittier Highly Capable (STRIVE)

1267 Poplar St.

Clarkston, WA 99403

(509) 758-0961

Lewiston Junior & High Schools:

Jenifer Jr. High

1213 16th

Lewiston, ID 83501

(208) 743-8589

Sacajewa Jr. High

3610 12th

Lewiston, ID 83501

(208) 743-9436

Lewiston Senior High

1114 9th Ave.

Lewiston, ID 83501

(208) 743-5557

INTRAMURAL SPORTS

Lewis-Clark State College

Intramural Program Director

500 8th Ave.

Lewiston, ID 83501

Elementary School Intramurals

McGhee

636 Warner Ave.

Lewiston, ID 83501

(208) 743-5991

Webster

1409 8th St.

Lewiston, ID 83501

(208) 743-5821

Whitman

1840 9th Ave.

Lewiston, ID 83501

(208) 743-6421

LEWISTON PRESCHOOL, PRIVATE AND SPECIAL SCHOOLS

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38 (teaching aides and recreation):

KinderCollege

Lewis Clark State College

(208) 799-2254

St Stanislaus Tri-Parish School

641 5th Av

Lewiston, ID

(208) 743-4411

Northwest Children's Home, INC

Administrative Office

419 22nd Av

743-9404

Special Education Center

602 13th

746-8206

CORPORATE FITNESS AND WELLNESS

Potlatch Corporation

805 Mill Road

Lewiston, ID 83501

GUIDES & OUTFITTERS/OUTDOOR LEADERSHIP

Barker River Trips

2124 Grelle

Lewiston, ID 83501

Boys Scouts of America

Inland Northwest Council

915 6th St.

Clarkston, WA 99403

OARS Dories

Curt Chang

HEALTH/FITNESS CLUBS/WELLNESS INSTRUCTION

Lewis-Clark State College

Fitness/Wellness & Skill Course Instructor Assistant

Health and Kinesiology Coordinator: Dr. Betsy Van Clief

500 8th Ave.

Lewiston, ID 83501

792-2277

Adcope Athletic Club

625 21st St.

Lewiston, ID 83501

(208) 746-7472

Curves for Women

1702 21st Street

743-3200

Gold’s Gym

621 Bryden Ave

798-8888

HEALTH SERVICES and RETAIL

North Central Health Dept

215 10th Street

Lewiston,Id

799-3100

Multiple Sclerosis

Inland Northwest Chapter

(800) 726-2826

American Red Cross ORTHO PRO

Lewis-Clark Chapter 16TH Ave

313 D St. Lewiston, ID 83501

Lewiston, ID 83501

NUTRITION

Pautler Senior Center 549 5th St.

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39 Clarkston, WA 99403

(509) 758-4064

St. Joseph Regional Medical Center-

Nutrition Dept

1250 Idaho St.

Lewis-Clark State College

Senior Nutrition Program

500 8th Ave.

Lewiston, ID 83501

(208

743-6983

PHYSICAL AND OCCUPATIONAL THERAPY

St. Joseph Regional Medical Center

Occupational Therapy

4th Ave. & 6th

Rehabilitation Services Dept.

1250 Idaho St.

Lewiston, ID 83501

(208) 799-5219

Tri-State Health & Rehab Center

Occupational Therapy Dept.

1255 Belmont Way

Clarkston, WA 99403

(509) 758-5573

Lewiston Schools

Lewiston, ID

(208) 746-7051

Gretchen Gundy

Clarkston Physical Therapy

Rod Scrimsher, M.P.T.

1366 Bridge St.

Clarkston, WA 99403

(509) 751-8666

Institute of Physical Therapy

Larry Ohman, RPT

678 Southway Ave.

Lewiston, ID 83501

(208) 746-1418

S.P.O.R.T. Physical Therapy Clinic

Bill Neumayer, P.T.

Kelly Steiger, P.T.

Bryden Canyon Center

328 Warner Dr.

Lewiston, ID 83501

(208) 746-7573

St. Joseph Regional Medical Center

Rehabilitation Services Dept.

1250 Idaho St.

Lewiston, ID 83501

(208) 799-5219

Twin Rivers Physical Therapy

Chip Wahlberg, P.T.

1207 Evergreen Ct.

Clarkston, WA 99403

(509) 758-8510

RETIREMENT/SENIORS

OCCUPATIONAL THERAPY, PHYSICAL THERAPY, ACTIVITY DIRECTORS

Area Agency on Aging

124 New 6th

Lewiston, ID 83501

(208) 743-5580

Clarkston Care

1242 11th Street

Clarkston, WA 99403

(509) 758-2523

Evergreen Estates Retirement Community

1215 Evergreen Ct.

Clarkston, WA 99403

(509) 758-5260

Juniper Meadows

2975 Juniper Dr.

Lewiston, ID 83501

Lee Ann Norris- Activity Director

(208) 746-8676

Royal Plaza Retirement &

Care Center

2870 Juniper Dr.

Lewiston, ID 83501

(208) 746-2800 Retirement Center

(208) 746-2855 Care Center

e-mail [email protected]

St. Joseph Regional Medical Center

SeniorLife

4th Ave. & 6th

Lewiston, ID 83501

(208) 799-5529

Tri-State Health & Rehab Center

1255 Belmont Way

Clarkston, WA 99403

(509) 758-5573

SPORTS GOODS-RETAIL

Army Navy Economy Store

827 D St.

Lewiston, ID 83501

(208) 746-6430

Follett's Mountain Sports

1019 21st St.

Lewiston, ID 83501

(208) 743-4200

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40 Gart Sports

625 21st St.

Lewiston, ID 83501

(208) 746-8040

Big 5 Sporting Goods

2310 Thain Grade

798-4859

SPORT/RECREATIONAL SERVICES

Bryden Canyon Public Golf Course

445 O'Connor

Lewiston, ID 83501

(208) 746-0863

Clarkston Golf and Country Club

1678 Elm Street

758-9354

Lewiston Golf and Country Club

3985 Country Club Drive

746-2801

Lewiston Parks & Recreation

Lynn Moss

Administration 1424 Main St.

Lewiston, ID 83501

Northwest Children's Home Inc.

602 13th

Lewiston, ID 83501

(208) 743-9404

YWCA

300 Main St.

Lewiston, ID 83501

(208) 743-1535

Gateway Golf Center

725 Port Way, Clarkston

758-4366

Martial Arts America

519 Thain Road

798-8324

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