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Welcome to your last step before your degree!! Please read through each step of the internship application. Complete all the required forms ensuring all the necessary information, dates, and signatures are completed.
The quality of the internship – both the degree of professional experience gained by students and the quality of work they perform – is impacted by the plans made and recorded in the Educational Agreement. The Educational Agreement provides the framework that ensures everyone is on the same page and working together as the student progresses toward completing the requirements needed for graduation.
1. With the exception of the student’s and Agency Internship Supervisor’s signature, this form must be typed and should be completed by the student with, or after, consultation with the Agency Internship Supervisor.
2. Section A - All information related to the Agency Internship Supervisor must be for the student’s on-site supervisor. If for some reason there is a need to change the Agency Internship Supervisor before or during the internship experience the Student Educational Agreement must be resubmitted to reflect the change in the Agency Internship Supervisor.
3. Section B - The student’s overall internship responsibilities should be listed in this section.
4. Section C – Experience Parameters
a. Beginning and End dates of the internship - The beginning date of all internships is the on the first Monday of semester classes. The ending date of the internship is 12 (spring, summer, fall) weeks following the beginning date.
Although the student may begin the experience prior to the official internship start date, or may end the experience after the official ending date, the student’s official internship experience is between the start and ending dates as listed above. Any time before or after the official start and ending dates is between the student and the agency and is not reportable as part of the course requirements. Hours and activities prior to and after the official start and ending dates should not be reported as part of the course requirements.
Recognized agency holidays do not require an extension of the ending date of the internship as long as the total required internship hours are met. However, if the student and agency agree upon a leave other than recognized agency holidays (i.e. spring break, extended holiday time off, family emergency) the ending date of the internship must be extended accordingly.
b. Work schedule – This is a general work schedule and it is recognized that the students weekly hours may vary based on agency needs. It is further recognized that some internship experiences will require longer than normal 8-hour days (i.e. a weekend special event). On average, the student should work 40 hours per week.
c. Holiday and sick leave arrangements – This should specify recognized agency holidays (i.e. Fourth of July, 2 days for Thanksgiving, etc.) as well as any other planned and agreed upon time off (i.e. 4 days to attend sister's wedding in Las Vegas). The agency policy in case of illness or emergency should be specified (i.e. the student should notify their supervisor by email/phone prior to the scheduled work hours).
d. Compensation/remuneration – Any hourly wage, salary, stipend, bonus, personal vehicle use reimbursement, housing, etc. provided to the student should be specified.
e. Student and Supervisor meetings – How often the student and Agency Internship Supervisor will formally meet to discuss the student’s progress should be specified (i.e. every Friday, every other Friday, immediately following the weekly staff meeting).
f. Other requirements/arrangements to be made – This section should specify the requirement and responsible party (i.e. the student will successfully complete Red Cross First Aid certification at the Agency’s expense, the student will be required to have a criminal background check conducted at their expense).
5. Section D - Student Agreement – The student should type in their name in the provided space and read the agreement.
6. Section E – Agency Internship Supervisor Agreement – The student should type in their on-site Supervisor’s name.
7. After completing all the required sections the student should print out one copy, sign and date Section D in the space provided. Have his/her Agency Internship Supervisor sign and date Section E in the space provided.
8. The student should print out two additional copies of the completed and signed form. One copy to be maintained by the student and one copy should be provided to the Agency Internship Supervisor.
From the time the student declared a major in our School, we stress the progressive development of core competencies, which our faculty believe are common to all types of agencies associated with our majors. Core competencies are developed through course content (knowledge), and the knowledge applied (skill or ability) through course projects/assignments, as well as through their required Career Field Exploration experiences, which they must complete before they are eligible for a Senior Internship.
1. The form must be completed by the Agency Internship Supervisor. The form does not have to be typed.
2. For each of the Core Competency Group Experience Items, the agency internship supervisor should indicate one of the following levels of experience. a. No exposure (not an option for TR students NCTRC competencies) b. Knowledge developed through discussion or observation. c Skill developed through the student’s exposure within his/her responsibilities. d. Ability developed through the student’s direct responsibility within the Experience Item.
3. The completed Agency Internship Supervisor Core Competency Worksheet is returned to the student and is included as part of the packet with the other required forms.
Students who wish to complete an internship at the same location where they currently work must complete this form. The purpose of the form is to allow the student to demonstrate new responsibilities, projects, and or assignments that significantly differ from their current responsibilities. The student’s internship experience must build upon competencies and skill areas that the student is not familiar with or has knowledge of in their current position.
1. This form should be completed by the student and must be typed.
2. Student Name – The student should type in their name in the space provided
3. Student ID# - The student should type in their student identification number in the space provided.
4. Location Name – The student should type in the name of their internship agency.
5. In the space provided under “Current Job/Position” the student should list (numbered or bullet points) their current job responsibilities and what skills or competencies they have strengthened as a result of these responsibilities.
6. In the space provided under “Additional Internship Responsibilities” the student should list (numbered or bullet points) what new tasks, projects, assignments, and responsibilities, they will complete to satisfy the internship requirements and identify what competencies they plan to strengthen or develop by completing these new responsibilities.
7. Upon completing the Internship Work Variance form, the student should print a hard copy and include it as part of the packet with the other required forms.
The “Student Placement Agreement” for unpaid internships or the "Paid Internship Agreement" for paid internships is a required agreement between Arizona State University and the Internship Agency. This form will be sent to the agency supervisor for electronic signature. You as a student do not need to do anything here. Just let your supervisor know they will be receiving an email requesting their electronic signature.
CAUTION: Under no circumstances will an internship be approved without the Internship Agency’s willingness to complete this form. The Agency may require the Student Placement Agreement or Paid Internship Agreement form to be reviewed by their legal counsel and this can take some time.
Your DARS will be checked one last time to ensure all required coursework is complete. Once your packet is submitted electronically, Manny Padia who is the Clinical Assistant Professor will review the packet. Please allow a week response time. If your internship is approved you will receive an override to the TDM/NLM/CSM/PRM 463 Intership Course.