Date Submitted ______________
APPENDIX B
INTERNSHIP INFORMATION SHEET
Macomb
QC
Department of Recreation, Park and Tourism Administration
Western Illinois University
This information is needed before an agreement can be initiated
PLEASE PRINT LEGIBLY
Name:
ID Number:
WIU email address:
Personal email address:
______________________________________________________
Address during Internship:
(if you don’t know it, leave blank)
Home & or cell telephone number:
(during internship)
Name of Internship Agency:
Agency address:
Agency’s telephone number:
Agency’s email/home page:
Name of Agency Supervisor:
Title of Supervisor:
Dates of Internship Agreement:
beginning date
ending date
# of weeks
RPTA OFFICE USE ONLY
Date agreement form is sent to agency: ________________ Date returned:______________________
RPTA Faculty Advisor: _______________________________________
Weekly reports:
1 ____/___ 2 ____/____ 3 ____/___ 4 ____/____ 5 ___/____ 6 ____/____
Content/Presentation
7 ____/____ 8 ____/____ 9 ____/____ 10 ____/___ 11 ___/___ 12 ___/___
13 ___/___ 14 ___/____ 1 5 _____/____
Midterm evaluations:
Intern _______ Agency Supervisor ________ Presentation________
Agency Supervisor’s Final Evaluation: __________
Recommended grades: ________
Special Project:____________________
________ ________ _________ _________
Date grades recorded: __________________________