EDLD 798 Internship Contract and Grade Report Educational Leadership Doctoral Program V.09232016

EDLD 798 Internship Contract and Grade Report Educational Leadership Doctoral Program v.09232016

Student Name WKU ID

(Last) (First) (M/M) STUDENT INSTRUCTIONS: Please use the contract below to describe and obtain approval for your planned internship experience (Step 1). After the internship, complete Steps 2-6, and submit all documentation to the Educational Leadership Doctoral Program Office. Complete a separate EDD Form 6 for each internship in your program and do not submit this form until all steps are complete. One hundred clock hours of internship activities are required to earn three semester hours of EDLD 798 credit.

STEP 1. INTERNSHIP CONTRACT Location of Internship

Site Supervisor Contact Information

Planned Internship Beginning Date Ending Date

Learning Objectives Planned Activities to Demonstrate (Specify your professional objectives for the Completion of Objectives internship.) (May be modified during the internship.)

Signatures below indicate acceptance or approval of this internship assignment.

Student Signature Date

_ Site Supervisor Signature Date

_ Advisor/Chair

Signature Date

_ STEP 2. INTERNSHIP ACTIVITIES LOG: Use the log format below to keep record of your internship activities.

Date Description of Activities Hours

Note: If you need to log additional activities, use pages 7 and 8.

STEP 3. INTERNSHIP REFLECTION: Type a brief (2-3 pages) reflection about your internship experience. Reflect on what learning objectives and planned activities described in Step 1 did/did not take place. Describe how the internship affected your professional growth as a leader and/or researcher, as well as your planned next steps to continue your professional growth.

STEP 4. SUBMISSION OF INTERNSHIP CONTRACT, ACTIVITIES LOG, AND REFLECTION (STEPS 1-3) AS A “CRITICAL PERFORMANCE” TO THE WKU ELECTRONIC PORTFOLIO SYSTEM. Login into the WKU EPS (http://edtech2.wku.edu/portfolio/) and submit your contract, log, and reflection as one document to your EDLD 798 course. The Educational Leadership Doctoral Program Office will score this critical performance based on your reflection and the evaluation of your site supervisor (Step 5). STEP 5. INTERNSHIP PERFORMANCE EVALUATION: Complete the information below and ask your site supervisor to complete the evaluation.

Student Name WKU ID (Last) (First) (M/M)

Location of Internship

Planned Internship Beginning Date Ending Date

Completed by Student/Intern Completed by Site Supervisor Please indicate the level of progress the intern made toward each learning objective listed. Learning Objectives No Some Satisfactory Superior (Copy the objectives specified in your original contract.) Progress Progress Progress (3) Progress (1) (2) (4)

Supervisor Comments:

Supervisor’s Overall Rating:

Site Supervisor Signature Date

*Supervisors: Please continue and complete the next two pages. Be sure to provide your signature again at the bottom of page 5. Supervisor Instructions: In the Score column, please rate (1-5) the intern on the following characteristics. For the extremes and middle ratings, behavioral anchors are provided as examples to guide assessment of each disposition. If for any disposition you are unable to provide a rating, write NO for “Not Observed” in the Score column.

Rating → Below At Standard T Score Indicator ↓ Stan 2 3 4 a Consistently attends internship and is on time. Exhibits a pattern of absence Occasionally misses work and is rarely tardy. Tries to a. Values Usually notifies supervisor in advance and and/or tardiness. Fails to notify supervisor if going to be absent or contacts learning: arranges to meet supervisor following absence. contact supervisor to make up supervisor following absence with adequate reason. Attendance Usually gives adequate reason for planned missed work. Gives no or absence. inadequate reason for b. Values Actively engaged and interested in the Inattentive to internship Is attentive and productive during internship assignment. learning: internship activities. Volunteers when assignments. Rarely Attention is focused on work- related materials and Internship appropriate. Participates in discussions and participates in discussions or activities participation problem-solving as needed. engages in problem-solving. Work completed with little Work is completed with attention to detail, is Assignments are completed correctly and with accuracy. c. Values attention to quality. May be sequential, and is logical. Shows evidence of Work shows basic grasp of the assignments intent. Meets learning: sloppy and/or contain thoughtful analysis of the assignment. Work assignment deadlines adequately. Is prepared for Internship errors. Emphasis on getting shows that adequate time and planning were internship most of the time. preparation work done rather than allocated. Consistently comes to internship learning. Assignments are well prepared. Usessometimes incorrect late grammar or missing. in oral Uses correct grammar in oral and/or written and/or written Usually uses correct grammar in oral and written d. Values communication. Communication is free of communications. May use communication. Generally uses language that is learning: offensive or inappropriate language. Uses slang, profanity, inappropriate appropriate and not offensive. Can convey ideas Communication language to express ideas very effectively vocabulary, or offensive accurately. regardless of the age of the listener. language. Does not express Emotionsideas clearly. are Maynot under display Displays steady emotional temperament. Is e. Values control. May lose temper and Maintains basic control of emotions. May show receptive to viewpoints of others and their personal show outbursts of anger. Is emotional reaction, but does not lose temper or control. suggestions. Holds self accountable for integrity: disrespectful of peers and Is able to listen to the perspectives of others. Is emotions and behaviors. Displays a sense of Emotional others. Does not take personal responsible for emotions and behaviors. humor and/or willingness to get along with control responsibility for emotions and others. behaviors. Blames others or outside circumstances for loss Is honest in dealing with others. Puts truth Shows pattern of dishonest or f. Values personal integrity: Is truthful and honest in dealing with above personal need or advantage. Always deceitful behavior. Fails to use Ethical behavior others. Uses discretion in keeping dependable in terms of keeping personal and discretion in keeping personal personal or professional confidences. professional confidences. Can be counted on confidences. Cannot be Strives to be trustworthy and to keep to follow through and keep word. Shows self counted on to keep word or to word. to be a person of strong character. follow through as promised. Rejects those who are Accepts others who are different in Willingly works with others from different different in ability, race, ability, race, gender, or ethnicity. ability, race, gender, or ethnic groups. gender, or ethnicity. Displays g. Values diversity Displays respectful and responsive Welcomes feedback and interaction with intolerant, disrespectful, and behavior toward the ideas and views others. Listens carefully to others and respects unresponsive behavior toward of others. Interacts with others in a the views of those perceived as different from the ideas and views of others. polite and professional manner with self. Interacts in an impolite or those perceived as different from self. Doesunprofessional not collaborate manner or withconsult Actively seeks out and incorporates ideas of with others. Shows little regard Collaborates and consults with others. h. Values collaboration others. Willingly works with others to improve for people and their ideas. Does Accepts ideas of others. Relates the overall environment. Regularly shares not relate well with others. adequately with others. Shares information and ideas. Does not share information or information and ideas. Unawareideas. of internship site Aware of internship site rules and Knows internship site rules and policies. i. Values professionalism: Respect rules and policies. Sometimes policies. Usually follows them without Follows them consistently. Understands the for site rules, policies, and norms disregards known policies or being reminded by others. Accepts purpose of regulations and respects their restrictions. Wants exceptions reminders for breaches of rules or intent. Accepts responsibility for personally to be made for self or tries to policies, and does not attempt to following them in patterns of dress, behavior, get around established rules of circumvent them in patterns of etc. Does not recognize personal Recognizes personal limitations and strengths j. Values professionalism: Recognizes personal limitations and limitations or strengths. Does and uses them to best professional advantage. Commitment to self-reflection strengths. Accepts suggestions and not accept suggestions and Actively seeks suggestions and constructive and growth constructive criticism of others. constructive criticism of others. criticism. Regularly practices critical thinking. Demonstrates ability to think critically. Does not engage in critical Regularly engages in learning through self- Demonstrates ability to learn through thinking. Does not demonstrate reflection. self-reflection. *Rubric adapted from Wayda, V, & Lund,ability J. (2005).to learn Assessing through self- dispositions: An unresolved challenge in teacher education; Teacher candidates may know their subject, but are they suited for the job? The Journal of Physical Education, Recreation, & Dance, 76, p. 34.

Student Signature Date

Site Supervisor Signature Date STEP 6. INTERNSHIP VERIFICATION: Complete the information below and ask your advisor/chair to sign this page as verification that you have successfully completed your internship. Please note that it is your responsibility to ensure that the course information is complete and accurate.

Student Name WKU ID

(Last) (First) (M/M)

Location of Internship

Internship Beginning Date Ending Date

Internship Course Prefix and Section Number: EDLD 798- (Section Number)

Semester and Year of Course Enrollment:

Course CRN: (Five digit number available on Topnet).

Credit Hours:

By my signature below, I verify that the above student has successfully completed the internship experience associated with this contract.

Advisor/Chair Signature Date

For Internal Office Use Only

 Dispositions entered into WKU E-Pass (Date ).

 EPS (Step 4) upload scored (Date ).

 Grade change submitted (Date ). Date Description of Activities Hours Date Description of Activities Hours