SUMMER 2014 INTERNSHIPS

 Info packet & required forms are on my website:  then click on Internships link  120 total hours required  6 week term = 20 hours / week  Term = June 23 – Aug 1 st Hours CANNOT be counted until June 23 rd.

 Once you identify a site – it needs to be approved by me.  Complete Forms A, B & C  Salem Hospital and Samaritan Health Services do NOT need Form A – everyone else does!  TYPED except for signatures  Handwritten forms will NOT be accepted  Incomplete forms – 5 points will be deducted from final grade for each incomplete form.  Completed forms are due at next meeting.

Form A – Master Agreement This agreement is entered into this ___ day of ___ 20__ (“Effective Date” between Western Oregon University (WOU), an Oregon non-profit cooperation and education institution (WOU), and ____ (The “Experience Provider”) located at _____. For Experience Provider:For WOU: Name: Supervisor’s nameName: Janet Roberts Address:Address: 345 N. Monmouth Ave Telephone:Telephone: (503)  Make sure ALL blanks are filled in  The Experience Provider = the name of the company where you will be interning.

Form A – Master Agreement page 2 Experience Provider:Western Oregon University: By: (Signature)By: I will sign Name: Print supervisor’s nameName: I will print my name Date:

Form B – Student Agreement Student Name: Your name Internship Start Date: 6/23/2014 End Date: 8/1/2014 Department and Course Number: Either HE419 or PE419 Quarter Enrolled: SummerYear: 2014Credit Hours: 4 Internship Site (“Experience Provider”): Internship Company Name Complete Internship Address: Street #, Street, City, State, Zip Site Supervisor: Supervisor’s first and last name Phone: Supervisor’s phone# Supervisor’s

Form C - Objectives  Fill out the top of the form  Do NOT hand forms to your site supervisor to fill out!  Objectives need to be TYPED and in correct format (see instructions)  You will need to meet with your site supervisor before you start your internship to determine objectives.

Forms  Experience Provider = Internship Site  On form A; for WOU = my name / contact info  KEEP a copy of form C for your records.

Upcoming Meetings  Meetings are MANDATORY!!  Tuesday, June 24th, 4pm, location to be determined  Midterm check-in – individual meeting  Monday, August 4 th, 10am, location to be determined

 Check WOU regularly