SUMMER 2015 INTERNSHIPS

 Info packet & required forms are on my website:  then click on Internships link EXERCISE SCIENCECOMMUNITY HEALTH EDUCATION 120 hours required (20 hrs/week)240 hours required (40 hrs/week) Terms runs from June 22 nd – July 31st. Hours cannot be started until June 22 nd and forms MUST be received on June 23rd. If forms are late, hours may NOT be counted until forms are received.

 Once you identify a site – it must be approved by me.  Complete Forms A, B & C  Salem Hospital, Samaritan Health Services & Marion Co Health Department 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 _____.  First line example: 20 th day of April 2015  _______ (The “Experience Provider”) = company name NOT person’s name  Located at __________ = physical address (street address, city, state, zip)  Make sure ALL blanks are filled in  The Experience Provider = the name of the company where you will be interning.

Form A continued – Page 1 For Experience Provider:For WOU: Name: Name: Janet Roberts Address:Address: 345 N. Monmouth Ave Telephone:Telephone: (503) NOTE: For Experience Provider: name may or may not be supervisor’s name it might be legal representation of the company or human resources director, etc.

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

Form B – Student Agreement Student Name: Your name Internship Start Date: 6/22/2015 End Date: 7/31/2015 Department and Course Number: Either HE419 or PE419 Quarter Enrolled: SummerYear: 2015Credit Hours: 8/4 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)  “To research fall prevention programs by July 15 th, 2015.”

Form C continued  You will need to meet with your site supervisor before you start your internship to determine objectives.  KEEP a copy of form C for your records.

Upcoming Meetings  Meetings are MANDATORY!!  Tuesday, June 23rd, 4pm, HWC306  Monday, Aug. 3 rd, 10am, HWC301

 Check WOU regularly  HE419 – CRN 1127 – 8 credits – A-F  PE419 – CRN 1178 – 4 credits – A-F