SAN FRANCISCO STATE UNIVERSITY
Department of Child and Adolescent Development
CAD Internship Application
for Bulletin Years 2011-2012 and Newer
Deadline: Please submit during two week window as posted on CAD website.
http://cad.sfsu.edu/
Failure to comply will result in having to reapply for an internship the next semester.
I am applying for:  Spring 20__  Fall 20__
 Yes, I acknowledge that my internship will take place during my last semester of my
senior year
A. Student Information
Last name:
First name:
Middle initial:
Student ID:
Concentration (EC,SA,YW,PAS)
Expected graduation semester:
CAD Major Bulletin Year you are following (i.e. 2011-2012):
SFSU email only:
Cell phone:
Local address (indicate if same as permanent address):
Permanent address (indicate if same as local address):
B. Relevant Experience Working With Children and/or Youth – Paid Experience
Employer
Position
Age Group
Served
Dates of Employment
Position
Age Group
Served
Volunteer Dates
Volunteer Experience
Employer
C. Describe Your Career Goal(s) and Future Educational Goal(s)
Career Goal(s)
Educational Goal(s)
San Francisco State University  CAD Internship Application  page 1 of 3
SAN FRANCISCO STATE UNIVERSITY
Department of Child and Adolescent Development
D.
Courses Taken List only courses constituting CAD major program (for courses being taken currently, write in IP in
Grade column). If you took the equivalent of 1 and 2 at a community college, write the ACTUAL course prefix and
number of the course you took.
Dept & Course #
1.
2.
3.




Title of Course/Prefix and number of
the course you took
Semester
/Yr
Grade
Institution
CAD 210 or
SFSU equivalent
CAD 260 or
SFSU equivalent
4.
5.
6.
7.
8.
9.
10.
11.
12.
13.
14.
15.
16.
17.
18.
19.
20.
21.
22.
TOTAL UNITS
Total # of CAD units completed before internship semester begins – includes in progress (copy # from
above)
Grade Point Average in CAD Major
Grade Point Average in ALL college work
San Francisco State University  CAD Internship Application  page 2 of 3
Units
SAN FRANCISCO STATE UNIVERSITY
Department of Child and Adolescent Development
E.
CAD Policy Agreement – Please read and initial each of the following items
Initial
each item
Area of Understanding and Agreement
1.
2.
3.
4.
5.
6.
7.
8.
It is CAD Department policy that all CAD interns meet the requirements outlined for their areas of concentration and
CAD major Bulletin Year that they indicated they are following. Internships must be in area of concentration.
CAD interns must be knowledgeable about and adhere to CAD Department policies. This includes reading and
adhering to information given to you in orientation, via the Internship Manual and CAD website, and by CAD faculty
advisors, the CAD Internship Coordinator, and CAD staff.
Early Childhood (EC) interns are required to do their internships at the SFSU campus during Fall and Spring semesters.
School Age (SA) interns are required to do their internships in a K-5 diverse elementary school classroom (may also
include programs whose activities are implemented in K-5 classrooms, i.e. Reading Partners) during Fall and Spring
semesters. Youth Work & Out of School Time (YWOST) and Policy, Advocacy, & System (PAS) interns can do their
internships during Spring and Fall semesters. See CAD website for list of possible agencies or types of agencies.
Interns might have to make adjustments to work and/or other schedules in order to complete internship hours and
accommodate the agency needs.
Interns should plan to be at an internship agency approximately 10 hours per week, over a minimum of 12 weeks
during the fall and spring semesters. Early Childhood interns are required to stay at the site over a minimum of 15
weeks during the Fall and Spring semesters to ensure continuity of care in the classrooms.
CAD concentrations dictate the time of day interns need to be available. Ensure that you will be available when you
are needed. This will allow you to get the most meaningful experience.

Early Childhood – available mostly morning hours

School Age – available during school hours

Youth Work & Out of School Time – available after school and sometimes on weekends when most programs
are offered (site requirements vary)

Policy, Advocacy and Systems – available during normal business hours– site requirements vary
An internship position is a professional placement from which interns can be fired by either the site supervisor or
CAD Department faculty for misconduct or lack of adherence to site and/or CAD Department policies. If an internship
is terminated, the intern must meet with the CAD Internship Coordinator to discuss the situation in order to
determine the possibility of any future placement. The intern will need to reapply for a future semester to redo both
the internship fieldwork hours and seminar. The intern will not be automatically transferred into the next semester
and will need to resubmit an internship application for the intended semester by the posted deadline.
If for any reason an intern does not start an internship in the semester for which he/she has applied, the intern will
need to reapply for a future semester by the designated deadline.
A SFSU internship contract is required for all interns, except for those who are placed at the following:
a) SFUSD, and, b) SSFUSD. Those interns do not need to submit a signed contract to CAD.
Your placement is not finalized until the CAD Internship Coordinator sends you confirmation via email.
I have read, understand, initialed, and agree to all of the items above.
Signature ________________________________________________________________
Date ________________
You can submit your application to the CAD office in one of the following ways: (1) walk-in to SCI 394, (2) fax to 415-405-0401,
(3) scan and send via email to: cad@sfsu.edu, or (4) mail to: CAD SFSU, 1600 Holloway Avenue, College of HSS, San Francisco, CA
94132.
Check your application carefully. Incomplete applications will not be processed; you will be asked to come in person to the CAD
office to complete it. We will not do this for you. You will receive a confirmation email approximately 4-5 days of the CAD office
receiving your application unless you hand deliver it to the CAD office. If you mail in your application, allow at least one week for it
to reach the CAD office. It must be in the CAD office (not postmarked) by the deadline. Call 415-405-3561 to follow-up.
If
youOffice:
wish to415-405-3561,
make an advising
appointment, please
come toare
thedue:
CAD September
office to sign
If you
wishp.m.
to send an email to CAD
CAD
cadint@sfsu.edu
Applications
20,up.
2012
by 4:00
Internship Coordinator, Dr. Nadine Agosta, the email address is: agosta.nadine@gmail.com
San Francisco State University  CAD Internship Application  page 3 of 3
SAN FRANCISCO STATE UNIVERSITY
Department of Child and Adolescent Development
Early Childhood (EC) Internship Applicants Only
Internship Documentation of Hours
Requirement: Documentation of 150 hours of work with children
For: EC CAD majors following CAD Bulletin 2011-12 and beyond
Instructions:
Students must submit a letter or email to the CAD Internship Coordinator documenting 150 hours of work
(paid/volunteer) in a licensed child-care center. The majority, if not all, of the 150 hours are to be completed at
one site/classroom with the same supervising teacher. This is to ensure a concentrated, focused experience
where you have become part of a teaching team, received supervision/training regarding your interactions with
children, and became an integral part of the classroom in order to build relationships with the children. The 150
hours excludes observation hours. Please keep a copy of this letter for your own records.
Documentation and hours completed are due:
1) Completion of hours and documentation is due to the CAD office by the beginning of the school semester that
you are beginning your internship (not necessary to have completed hours when submitting an application).
If you submit an email, it must:
1)
2)
3)
4)
Be written by a supervisor and/or director of the center (not the student)
Be addressed to: Dept. of Child & Adolescent Development, SFSU and sent to: cad@sfsu.edu
State the student’s name
State the number of hours completed; the hours must be supervised (paid/volunteer) and in direct care and
interaction with children
5) Include the name, address, phone number of the childcare center
6) Include the license # of the childcare center
7) Include the name and title of the person writing the email
If you submit a letter, it must:
1) Follow the guidelines listed above
2) Be typed on the childcare center letterhead
Course Substitution
Students who have completed an early childhood practicum course at a community college may submit a Course
Substitution Form to count those hours toward the required 150 hours. The Course Substitution form can be found
on the CAD website under Advising – Advising Basics. Submit it with your Internship Application. You will be
notified via email if your request for course substitution was approved or denied.
Submit Your Documentation
You can submit your documentation to the CAD office in one of the following ways: (1) walk-in to SCI 394, (2) fax
to 415-405-0401, (3) scan and send via email to: cad@sfsu.edu or, (4) mail to: CAD SFSU, 1600 Holloway Avenue,
College of HHS, San Francisco, CA 94132 (must be in the CAD office, not postmarked by the deadline).
San Francisco State University  CAD Internship Application  EC Plan for Completing 150 Hours