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Kinesiology & Health
INTERNSHIP
HANDBOOK
!
Lewis-Clark State College
Lewis-Clark State College
Kinesiology and Health Program
Internship &
Practicum
Handbook
Contact Person:
Dr. Betsy Van Clief
208-792-2277
Updated 8/26/2009
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
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
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.
3
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
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.
5
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
6
Appendix A
Course Syllabus
o Syllabus: KIN/HLTH/REC 494 Internship
o Syllabus: KIN/HLTH/REC 495 Practicum
7
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:
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
8
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
9
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.
10
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
11
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.
12
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:
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,
13
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.
14
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
15
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.
16
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
17
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
18
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
19
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
20
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:
21
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:
22
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?
23
Page #:
Time Log Health and Kinesiology Practicum/Internship
Date Time In Time Out # hours
worked
List of work/ accomplishments
Intern Signature:
Site Supervisor Signature:
24
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
25
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:
26
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
27
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
28
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
29
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
30
33
(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
34
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
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
36
Appendix C
o Internship Sites
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
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.
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
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