Grad Year:

Address: 

Campus Box:  Phone:

Internship Semester:  Internship Year:  Course No: Department:

Major: Faculty Supervisor:

Internship title: Start Date: End Date:

Company or Agency Name:

Company Address: Work Supervisor:

Supevisor Phone: Title: Approx. hours per week:

Compensation: Unpaid Paid Amount

Paid by off-campus work study: Yes No

NOTE: You must complete a minimum of 140 hours of work per course credit.

Internship Work Component/Job Description:

Give a general description of the internship job responsibilities, tasks and learning opportunities. This is to be determined by the work supervisor and the intern.

INTERNSHIP ACADEMIC COMPONENT:
Write 2-3 learning objectives for each of the following categories and include specific strategies for each objective. Include at least one method of evalution for each objective. The academic component is determined between the faculty supervisor and the intern.

Learning Objectives should include:
1. Application of concepts or theories of your major and your liberal arts education and/or development of new knowledge and understanding.
2. Skill development related to your major or an occupation; and/or general skills such as oral and written communication, critical thinking, organization, problem solving, decision making, leadership, interpersonal relationships, technical, etc.
3. Personal development such as self-awareness, self-confidence, sensitivity and appreciation for diversity, clarification of work and personal values, career and professional development.

1. LEARNING OBJECTIVE ONE:
What I want to learn or be able to do.

LEARNING ACTIVITIES FOR OBJECTIVE ONE:
How I am going to learn it & what resources I will use.

EVALUATION METHODS FOR OBJECTIVE ONE
How I am going to show I learned it.

2. LEARNING OBJECTIVE TWO:
What I want to learn or be able to do.

LEARNING ACTIVITIES FOR OBJECTIVE TWO:
How I am going to learn it & what resources I will use.

EVALUATION METHODS FOR OBJECTIVE TWO
How I am going to show I learned it.

3. LEARNING OBJECTIVE THREE:
What I want to learn or be able to do.

LEARNING ACTIVITIES FOR OBJECTIVE THREE:
How I am going to learn it & what resources I will use.

EVALUATION METHODS FOR OBJECTIVE THREE
How I am going to show I learned it.

4. LEARNING OBJECTIVE FOUR:
What I want to learn or be able to do.

LEARNING ACTIVITIES FOR OBJECTIVE FOUR:
How I am going to learn it & what resources I will use.

EVALUATION METHODS FOR OBJECTIVE FOUR
How I am going to show I learned it.

5. LEARNING OBJECTIVE FIVE:
What I want to learn or be able to do.

LEARNING ACTIVITIES FOR OBJECTIVE FIVE:
How I am going to learn it & what resources I will use.

EVALUATION METHODS FOR OBJECTIVE FIVE
How I am going to show I learned it.

6. LEARNING OBJECTIVE SIX:
What I want to learn or be able to do.

LEARNING ACTIVITIES FOR OBJECTIVE SIX:
How I am going to learn it & what resources I will use.

EVALUATION METHODS FOR OBJECTIVE SIX
How I am going to show I learned it.

SUPERVISION:

1. After consulting with your work supervisor, describe how he or she will supervise you.(meetings, regular feedback, etc.)

2. Describe the means and the frequency of communication between you and your faculty supervisor.

Student: Student Phone: Student Email:

Faculty: Faculty Phone: Faculty Email:

Supervisor: Supervisor Phone: Supervisor Email:

When you select "send form," your learning plan will be sent to: Lois Olson, Director of Internships, Center for Service, Work, and Learning, Anderson Hall, Lower Level, Augsburg College. 612-330-1474.

A copy will be sent to your faculty supervisor. Please make copies for your work site supervisor and yourself.