ࡱ> ;=: bjbjVV r(<<085,"aa(ddd^"`"`"`"`"`"`"$$c'("ddddd""dF^"d^"B l"r.BF!*J""0"!*(J(T"("Hddddddd"":Xddd"dddd(ddddddddd : Summary of Forms Forms I through IV should be completed by the agency and/or the internship coordinator only. Forms V through XI are for the intern to complete. FORM I - Internship Agency Questionnaire Note: Participating agencies have completed the questionnaire located in the internship coordinators office. Prospective interns may wish to review this information to help figure out their internship schedule. FORM II - Internship Agreement Enclosed with the internship agreement is a cover letter identifying the intern and the dates of the requested internship. Also enclosed are the following forms: Form VI- Student Information Form VII- Statement of Insurance Coverage Form VIII- Waiver and Release FORM III - Agencys Final Evaluation of Intern The Agency Coordinator should complete one of these forms (A, B, or C) and forward it to the universitys internship coordinator. Other agency personnel may complete the final evaluation, Form III, if the agency coordinator feels such evaluation would be more valid. FORM IV - Supervisors Midterm Report This report should contain a brief summary of the interns experiences and the impressions of agency personnel concerning the interns performance to date. Form V - Internship Schedule Prospective interns will complete this form after attending the mandatory internship meeting at least one semester before their scheduled internship. Per instructions, this form must be completed within a specific time and returned to the internship coordinator. Although the internship coordinator will consider the students proposed internship schedule, final scheduling may result in revisions. The internship coordinator will announce the verified internship schedule for each intern when final plans are completed with the agencies. Students should notify the internship coordinator upon completion of their initial agency interview. Additionally, students should allow two to three weeks after the initial meeting for agency consideration of their requested internship (accepted or denied). FORM VI - Student Information The prospective intern must complete an up-to-date typed Student Information for each agency with which s/he intends to participate (personal photograph attached to each form). The original Student Information will be maintained in the internship coordinators files. The internship coordinator will inform prospective interns when to submit the Student Information form. FORM VII - Statement of Insurance Coverage The prospective intern must complete a Statement of Insurance Coverage for each agency with which s/he intends to participate. The original Statement of Insurance Coverage will be maintained in the internship coordinators files. Persons who will be under the age of twenty-one (21) at the time of internship must have a parental signature. The internship coordinator will inform prospective interns when to submit the Statement of Insurance Coverage. When a student registers for the internship, this insurance is automatically in effect. FORM VIII - Waiver and Release The prospective intern must complete a Waiver and Release for each agency with which s/he intends to participate. The original Waiver and Release will be maintained in the internship coordinators files. Persons who will be under the age of twenty-one (21) at the time of the internship must have a parental signature. The internship coordinator will inform prospective interns when to submit the Waiver and Release. FORM IX - Students Midterm Evaluation of Internship This form is to be completed by the intern after the fifth week of internship and returned to the internship coordinator. FORM X Students Final Evaluation of Internship The intern will complete this form and return it to the internship coordinators office during the final week of internship. Form XI Internship Checklist The prospective intern can complete this form at the mandatory internship meeting as a reminder of important due dates and time constraints.     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