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Hea Spa Internship Forms (Saint Louis University)

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Student Name: ____________________________________
Internship Site: ____________________________________
Internship Supervisor: ______________________________
Please identify two competency areas (related to your internship
placement) from the ACPA/NASPA Professional Competencies document
in which you hope to advance:
COMPETENCIES:
1.______________________________________________________________________
2.______________________________________________________________________
Based on the criteria provided in the ACPA/NASPA Professional
Competency manual, please rate your skill-level for each of your chosen
competency areas (circle one level):
Competency #1: Beginner Intermediate Advanced
Competency #2: Beginner Intermediate Advanced
Please identify two learning objectives (specific ways in which you plan to
work on these goals) for each of your chosen competency areas:
COMPETENC
Y #1 LEARNING OBJECTIVES:
1.
Form A
SAINT LOUIS UNIVERSITY
HIGHER EDUCATION ADMINISTRATION
INTERNSHIP LEARNING OBJECTIVES
2
COMPETENCY #2 LEARNING OBJECTIVES:
1.
2.
EMPLOYER STUDENT
Internship Site: ___________________ Student Intern:_____________________
Supervisor’s Name: ______________ Student Address: __________________
Supervisor’s Title: _________________ ____________________________________
Dept.Address: ___________________ Student Phone: ____________________
_________________________________ Student Email: _____________________
Supervisor’s Phone: ______________ Faculty Advisor: ____________________
Supervisor’s Email:________________ Advisor’s Phone: ___________________
A. CONDITIONS OF INTERNSHIP
1. The internship will be _______ weeks in duration with an average of
_______ hours per week.
2. The internship will begin on _________________ (day/month/year) and will
end on or about ________________ (day/month/year).
3. The student will intern at the site on the following days and times (please
note your schedule):
______________________________________________________________________
4. The student intern and site supervisor will decide on work assignments
and projects that meet the following student’s learning objectives: (based
on chosen competency areas):
A._____________________________________________________________________
B. _____________________________________________________________________
C. _____________________________________________________________________
Form B
SAINT LOUIS UNIVERSITY
HIGHER EDUCATION ADMINISTRATION
INTERNSHIP AGREEMENT FORM
B. RESPONSIBILITIES OF STUDENT INTERN
1. The student intern is to be present at the internship site on the days
and times specified above.
2. If the student intern is ill or for other reasons cannot be present at
the site, he or she should inform the site supervisor of the absence as
soon as possible.
3. The student intern is expected to behave and dress professionally.
4. The student intern is expected to complete work assignments and
projects in a professional and timely fashion.
C. RESPONSIBILITIES OF THE SITE SUPERVISOR
1. The site supervisor should provide adequate training or informal
assistance when necessary.
2. The site supervisor should provide adequate feedback on the
student intern’s performance.
3. The site supervisor is should help the student intern gain professional
skills and knowledge.
The Student Intern and Site Supervisor agree to the above conditions and
responsibilities of the Internship.
Signature of Student Intern: ______________________________________
Date: _________
Signature of Site Supervisor: ______________________________________
Date: _________
Return form to:
Dr. Karen Myers
Saint Louis University
3500 Lindell Boulevard
Fitzgerald Hall
St. Louis, MO 63103
Office use only:
Reviewed: / /
Student Name: ____________________ Dates of Internship: ________________
Student Phone: ____________________ Internship Site:______________________
Student Email: _____________________ Supervisor Name: __________________
Please take a few minutes to evaluate your performance at the internship
site. Please evaluate yourself in comparison to other student
interns/employees.
PART ONE: PERRFORMANCE REVIEW
Please rate your performance by checking the box that corresponds with
your assessment of your performance in the current internship.
Rating Scale:
Excellent =5 Performance significantly above proficiency level
Above Average = 4 Performance above proficiency level
Average = 3 Proficient performance
Improvement Needed = 2 Performance below proficiency level
Unsatisfactory = 1 Performance requires considerable improvement
Not Applicable =NA Not applicable in this internship experience
WORK RELATED PERFORMANCE
5 4 3 2 1 NA
1. Work attitude
2. Academic preparation
3. Problem-solving ability
Form C
SAINT LOUIS UNIVERSITY
HIGHER EDUCATION ADMINISTRATION
STUDENT INTERN SELF-EVALUATION
4. Adaptability
5. Overall attendance
6. Progress towards learning goals
ORGANIZATIONAL SKILLS
5 4 3 2 1 NA
7. Time management skills
8. Planning skills
RELATIONSHIPS WITH OTHERS
9. Willingness to cooperate
10. Ability to work with supervisor
11. Accepts constructive comments
12. Ability to take direction
COMMUNICATIONS SKILLS
13. Oral communication skills
14. Written communication skills
15. Listening skills
OVERALL RATING
PART TWO: ACCOMPLISHMENTS
Please provide the following information about your internship experience.
If additional space is needed, please attach an additional page to this
evaluation.
1) Identify the most important learning goals, in relation to your chosen
professional competency areas, you had set for yourself when beginning
the internship.
2) How well do you feel you accomplished these goals in this internship?
3) List the activities that allowed you to accomplish your goals.
4) Identify any specific knowledge or skills gained during this internship
that have enhanced your chosen professional competency areas.
5) Describe any noteworthy accomplishments you achieved during this
internship.
Student Signature:_______________________________________
Date:____/____/_____
Return form to: Dr. Karen Myers
Saint Louis University
3500 Lindell Boulevard
Fitzgerald Hall
St. Louis, MO 63103
Office use only:
Reviewed: / /
Student Name: ____________________ Dates of Internship: ________________
Student Phone: ____________________ Internship Site:______________________
Student Email: _____________________ Supervisor Name: __________________
Please take a few minutes to evaluate your internship experience. This
evaluation will not
be shared with your site supervisor. The purpose of this
evaluation is to assist in the coordination of future Higher Education
Administration internships. If additional space is needed, please attach an
additional page to this evaluation
1) How would you rate this internship experience in terms of helping you
gain professional skills and knowledge?
Excellent Very Good Good Requires Improvement
2) How well did the work assignments/projects meet your professional
competency learning goals?
3) Did your supervisor provide adequate training or informal assistance?
4) Did your supervisor provide adequate feedback on your performance?
Form D
SAINT LOUIS UNIVERSITY
HIGHER EDUCATION ADMINISTRATION
STUDENT EVALUATION OF INTERNSHIP
5) Did your co-workers help you get acclimated to the site?
6) Did your co-workers display a willingness to work with you?
7) List any positive aspects of interning at this site.
8) List any negative aspects of interning at this site.
9) Would you recommend this internship site to another student?
Yes No
-Why or why not?
10) Overall, my internship experience was:
Extremely Valuable Very Valuable Valuable
Not Very Valuable Of No Value
Student Signature:_________________________________
Date:____/____/_____
Please Return form to: Dr. Karen Myers
Saint Louis University
3500 Lindell Boulevard
Fitzgerald Hall
St. Louis, MO 63103
Office use only:
Reviewed: _____/____/_____
Student Name: ____________________ Dates of Internship: ________________
Student Phone: ____________________ Internship Site:______________________
Student Email: _____________________ Supervisor Name: __________________
Please take a few minutes to evaluate the student intern’s performance at
your site. Once completed, please review your assessment with the
student intern. . The intern should be evaluated in comparison to other
student interns/employees.
PART ONE: PERRFORMANCE REVIEW
Please rate the student intern’s performance by checking the box that
corresponds with your assessment of the student intern’s performance.
Rating Scale:
Excellent =5 Performance significantly above proficiency level
Above Average = 4 Performance above proficiency level
Average = 3
Proficient performance
Improvement Needed = 2
Performance below proficiency level
Unsatisfactory = 1
Performance requires considerable improvement
Not Applicable =NA Not applicable in this internship experience
WORK RELATED PERFORMANCE
5 4 3 2 1 NA
1. Work attitude
2. Academic preparation
3. Problem-solving ability
Form E
SAINT LOUIS UNIVERSITY
HIGHER EDUCATION ADMINISTRATION
SUPERVISOR EVALUATION OF
STUDENT PERFORMANCE
4. Adaptability
5. Overall attendance
6. Progress towards learning goals
ORGANIZATIONAL SKILLS
2 1 NA5 4 3
7. Time management skills
8. Planning skills
RELATIONSHIPS WITH OTHERS
9. Willingness to cooperate
10. Ability to work with supervisor
11. Accepts constructive comments
12. Ability to take direction
COMMUNICATIONS SKILLS
13. Oral communication skills
14. Written communication skills
15. Listening skills
OVERALL RATING
PART TWO: ACCOMPLISHMENTS
Please describe any noteworthy projects or accomplishments the student
intern has completed during the internship. (If additional space is needed,
please attach additional page to evaluation.)
OVERALL EVALUATION
Please describe your overall evaluation of the student intern. (If additional
space is needed, please attach additional page to evaluation.)
Site Supervisor’s Signature:___________________________ Date:____/____/____
Please return form to: Dr. Karen Myers
Saint Louis University
3500 Lindell Boulevard
Fitzgerald Hall
St. Louis, MO 63013
Office use only:
Reviewed: _____/____/_____
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Completed 23 July 2020

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