Department of Instructional Design
and Technology
Western Illinois University
Instructional Technology Internship
IDT 499
Manual
1
This manual is subject to change.
Instructional Technology Internship
IDT 499 (6-12 sh)
Internship Guidelines
Internship Objectives
The Instructional Technology Internship provides qualified students with a
supervised opportunity of practical work experience in various career options. The
internship is a unique experience that offers specific goals relative to the intern’s
career and educational objectives.
This manual contains information about internship objectives, eligibility,
requirements, applications process, and forms specific to the internship.
The major objectives of the internship are:
• To provide the intern with relevant information about his/her career choice.
• To acquaint the intern with the physical, technical, and environmental requirements of
his/her chosen career.
• To develop the intern’s ability to search for and find employment.
• To provide the intern the opportunity to plan a practice program in his/her chosen
career.
• To provide the intern with practical experience in the field.
Internship Eligibility
• Student must have completed the IDT core courses with a 3.00 grade point average or
higher.
• Student must have successfully completed the University Writing Exam.
• Student must have successfully completed at least one Independent Study (IDT 489)
• Student must have attended the Internship Orientation.
• Student submits IDT 499 Request to Register in IDT 499 and all documentation at
least four months prior to anticipated date of internship.
Internship Requirements
•The intern will participate in planning the internship program with the on-site mentor.
• Intern could be given opportunities to plan, organize, and lead activities as well as
opportunities to observe and participate in other activities.
2
•The internship should include multiple experiences with more than one facet of the
sponsoring organization in order to provide an understanding of the total scope of its
instructional technology operations.
• Specific duties and opportunities are negotiated between the intern and the on-site
mentor.
•The intern will spend no less than 45 clock hours in professional fieldwork for each
semester hour of credit.
•The intern can earn from six to twelve semester hours but only six will apply to the
major.
• IDT 499 “ Instructional Technology Internship” is graded Satisfactory/Unsatisfactory.
• The intern will follow the rules, regulations, and policies of the sponsoring organization.
• The intern will prepare all forms, submits record, and reports required by the
department.
Internship Process
1. Four months prior to internship, student submits Request to Register in IDT 499
Internship and all documentation. Earlier applications are encouraged for some
competitive internship opportunities.
2. Student supplies all information and documentation about himself/herself, about the
company he/she proposes to intern with, about the site mentor, proposed duties, and
other relevant information.
3. Student meets with the Department Chair or his/her designee to present request and
discuss internship.
4. Once the student has received approval to do an internship, and a potential location
has been identified, the student may contact the sponsoring organization to determine
necessary application procedures.
5. Once accepted the Department and the sponsoring organization will complete and
sign Internship Agreement Forms. When necessary the sponsoring organization may
alter the specific statements to make the requirements appropriate to the institutional
setting or to meet the individual intern's needs. However, the Department of
Instructional Design and Technology must be made aware of these changes when the
form is signed.
Selection of Internship Location and On-Site Mentor
• Students are responsible for locating their own internship placement. However, a list
of locations where former students have done internships is available from the
Department. Also, companies and other entities may list themselves with the
Department expressing a desire to have interns.
3
Student Responsibilities
The Intern will:
• Complete all forms and arrangements regarding the setup of the internship. Forms
must be filed with the Department of Instructional Design and Technology.
• Prepare a statement that delineates the philosophy and objectives of the internship;
the progression and scope of the internship; and any policies and procedures agreed to
by the sponsoring organization. The Department Chair must approve this statement
before the student can begin his/her internship experience. A copy of the completed
“Internship Statement” will be given to the On-site Mentor.
• The intern will submit a Weekly Activity Log to the Department Chair or his/her
designee on a weekly basis.
• The intern will schedule periodic conferences with the on-site mentor, including
midterm and final evaluation meetings.
The intern will submit a final report, Evaluation of Internship Experience, and a copy of
all projects completed during the internship to the Department Chair.

On-site Mentor Responsibilities
The Mentor will:
• Negotiate with the prospective intern the goals and objectives of the internship
experience as well as specific arrangements such as scheduling, parking, etc.
• Read and sign Form 4: Internship Agreement.
• Provide supervision throughout the internship experience.
• Consult with the intern on a regular basis regarding progress. Review and revise the
learning experience as needed.

Complete a midterm report of the intern
 Complete a final evaluation of intern.
4
Faculty Advisor Responsibilities
The Advisor will:
• Keep a copy of all forms signed by students, the internship sponsoring organization,
and the department.
• Receive, respond to and file student and on-site mentor documents.
• Visit the internship location once during the internship experience.
• Review all intern and mentor documents in order to evaluate the internship.
• File an S/U grade.
Internship Forms
1. Internship Checklist
2. Internship Request Form IDT 499
3. Internship Waiver and Release
4. Internship Statement of Insurance Coverage
5. Internship Agreement
6. Weekly Activity Log
7. On-site Mentor Midterm Report of Intern
8. On-site Mentor Final Evaluation of Intern
9. Evaluation of Internship Experience by Intern
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IDT 499 Instructional Technology Internship
Frequently Asked Questions
1. Why should I consider doing an internship?
The IDT Internship will help you develop skills in searching for and acquiring
employment in a relevant field. During the internship you will discover your
strengths and weaknesses related to career expectations. You will have an
opportunity to observe and work with professionals in your field.
The IDT Internship provides you with job experience in your field, looks good on your
resume, helps you get a better job upon graduation, and gives you practical
experience in the field. It also gets you out of the classroom and into the real world.
2. When can I do the IDT Internship?
Most students do their internship during their senior year.
You must have completed the IDT core courses with a 3.00 grade point average,
which include IDT 200, 205, 230, 240, 310, 330, 345, 360, and 440. You also have
to have successfully completed the University Writing Exam, and have successfully
taken at least one IDT 489 Independent Study Project.
3. What are other requirements for the IDT Internship?
The IDT Internship must provide valuable practical work experience in instructional
technology, training or development, distance learning, multimedia or
telecommunication.
4. Where do I find information about the IDT Internship?
Most IDT students find their own internships from friends, family, and professional
contacts that they have. IDT faculty, WIU Placement Office and Job Market,
professional publications, and Sunday papers are examples of sources for
organizations that offer internships. The first rule of all internships is that your
current paid employer cannot provide you with an internship.
5. How many credits can I earn on the IDT Internship?
You can earn from six to twelve credits but only six apply to your major. IDT 499
Internship in Technology is graded S/U.
6. How many hours do I need to work on my internship?
In order to earn one credit hour you will need to work 45 clock hours. Your
internship can earn six to twelve credits. For example: if you were on a six credit
hour internship and worked 35 hours per week you would need to find an internship
for approximately six weeks. For this reason most students do their internships in
the summertime.
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7. How can I apply for the IDT Internship?
First discuss your plans with the IDT Chair. Have some specific goals and
objectives as well as possible places for the internship. Search for the organizations
for which you wish to intern. Then identify the supervisor at each organization who
is willing to be your mentor during the internship. Discuss with him/her your plans
and seek his/her input.
Fill out the Internship Request Form and turn it in with the other required documents
to the IDT Chair. After reading your application, you and your proposed mentor will
be contacted by an IDT faculty member. Details, legal, and sometimes financial
obligation and documentation need to be completed. Then a copy of your
application form will be returned to you with signatures indicating your internship
contract haws been approved by all.
8. Who assesses my work and how do I get a grade?
You mail in a weekly report detailing your progress and internship activities during
that week. A copy of this report should be filed with your mentor as well. Reports
should be sent to the Chair of the Department of Instructional Design and
Technology.
9. Where do I go if I have more questions?
Talk to the Department Chair, your favorite faculty members, and fellow students.
IDT Office: 309-298-1952; email: hh-hemphill@wiu.edu, fax: 309-298-2978.
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Undergraduate Internship Checklist
Getting Started
____
____
____
____
____
____
____
____
Completed the IDT core with a 3.0 GPA.
Completed University Writing Exam
Completed one Independent Study- Date completed:_______________
File IDT 499 Internship Application
Upon notification of internship approval, establish internship location.
Negotiate internship activities with sponsoring organization.
Secure signatures on Internship Agreement
Complete Internship Waiver and Release and Internship Statement of Insurance
Coverage
____ Prepare Internship Statement for faculty advisor approval and give a copy to the
on-site mentor.
During internship
____ Complete at least 45 clock hours of professional fieldwork for each semester
hour of credit.
____ File Weekly Activity Logs.
____ Meet periodically with On-site Mentor to discuss progress and plan continued
internship experiences.
____ Make sure the On-site Mentor has a copy of On-site Mentor Midterm Report of
Intern to complete and return to the Department at the midterm of the internship.
____ Contact the Department and arrange for a site visit.
At conclusion of internship:
____ Make sure the On-site Mentor has a copy of On-site Mentor Final Assessment of
Intern to complete and return to the Department at the end of the internship.
____ Write thank you notes to sponsoring organization and On-site Mentor.
____ Submit Evaluation of Internship Experience by Intern, a report of experiences,
and a sample of work completed by the due date agreed upon.
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Internship Locator -1
Graduate and Undergraduate Internships
Companies/areas where previous IDT students have interned:
•
Apex Communications and Training Solutions
P.O. Box 119
Effingham, IL 62401
217-342-6367
 Argonne National Laboratory
Internet Development
9700 S. Cass Ave.
Argonne, IL 60439
630-252-2000
 Arrowhead Ranch Residential School
12200 104th Street
Coal Valley, IL 61240
309-743-6100
 Aspect Communications
1310 Ridder Park Drive
San Jose CA 95131-2313
Aspect Education Services Bldg. 1A
409-325-4420

Athletic Media Services
Western Illinois University
Western Hall
309-298-1133
 Atomic Learning
c/o MediaSpinners, LLC
15088 22nd Avenue NE
Little Falls, MN 56345
855-259-6890
 Black Hawk College
Teaching and Learning Center
6600 34th Avenue
Moline, IL 61265
309-796-5036
9
•
Blue Interactive Productions
P.O. Box 102
Blandinsville, IL
309-652-3255

Caterpillar, Inc.
501 S.W. Jefferson
Peoria, IL 61630
309-636-5547
 Carl Sandburg College
2400 Tom L. Wilson Boulevard
Galesburg, IL 61401
309-344-2518
 Carthage Veterinary Service
34 W. Main
Carthage, IL 62321
217-357-2811
•
Center for the Application of Information
Technologies (CAIT)
Western Illinois University
College of Education and Human Services
Horrabin Hall 90
Macomb, IL 61455
309-298-1804

Center for Innovation in Teaching & Research
Western Illinois University
Department of Instructional Design & Technology
Macomb, IL 61455
309-298-2434
 Central State Bank
301 Iowa Ave
Muscatine, IA 52761-0074
563-262-3134
 Cohen Financial
2 N. LaSalle St. Suite 800
Chicago, IL 60602
312-346-5680/312-803-5747
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•
Collaborative Connections Ltd.
The Red Barn
Marchants Close
Hurstpierpoint
BN6 9UZ
United Kingdom
 Consolidated High School District #230
9001 W. 171st Street
Tinley Park, IL 60477
708-342-5800

Dallas City Elementary School
921 Creamery Hill Road
Dallas City, IL 62330
217-852-3201
•
Deere & Co.
1 John Deer Place
Moline, IL 61265
309-765-4599
 Design and Graphics
225 Sheridan St.
Rockford, IL 61103
815-963-2089
 Document and Publication Services
1 University Circle
Macomb, IL
309-298-1000
 Duncan Scott Productions
1526 145I #102
Santa Monica, CA 90404
310-393-806
•
Dwight Township High School
801 S. Franklin
Dwight, IL 60420
815-584-2904
11
 Forsythe Technology
7770 Frontage Road
Skokie, IL 60077
847-213-7447
 GenSoft Systems
319 J. F. Edwards Drive
Geneseo, IL 61254
309-944-8875
 Heartland Centers for Public Health & Community Capacity Development
St. Louis, MO 63104
St. Louis University
School of Public Health
319-977-8289
• iExplore
600 W. Fulton St. STE. 301
Chicago, IL 60661
312-627-8700
•
Illinois Central College
One College Drive
East Peoria, IL 61635
309-694-5422
 Illinois Department of Transportation
Division of Highways-District 2
819 Dept Ave.
Dixon, IL 61021
815-284-5492
 Illinois Department of Public Health
828 S. 2nd Street
Springfield, IL 62704
2217-524-6817
 Independent Contractor
1700 Old Deerfield Road
Highland Park, IL 60035
847-831-4800
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 IT Resource Center
29 E. Madison Avenue, Suite 1005
Chicago, IL 60602
312-372-4872
 John Deere Health, Inc.
1300 River Dr. Suite 200
Moline, IL 61265
309-765-1503

John Deere Training Center
8000 Jersey Ridge Road
Davenport, IA 52807
563-388-4507
 John Deere C&F Training Center
8000 Jersey Road
Davenport, IA 52807
563-388-4538
 John Wood Community College
1301 S. 48th Street
Quincy, IL 62305
217-641-4536
•
Karmak
One Karmak Plaza
P.O.Box 680
Calrinville, IL 62626-0680
800-252-7625
 Kirkwood Community College
6301 Kirkwood Blvd SW
Cedar Rapids, IA 52406
800-363-2220

Kennecott Utah Copper
8363 W 10200 S
Bingham County, UT 84006
801-569-6000
 Keokuk Area Convention and Tourism Bureau
329 Main Street
Keokuk, IA 52632
319-524-5599
13
 Keokuk School District
2940 Decatur St.
Keokuk, IA 52632
319-524-1402
•
Knox College
3 E. South Street
Galesburg, IL 61401
309-341-7355
 K & R Express Systems, Inc.
15 W. 460 Frontage Road
Hinsdale, IL 60521
312-323-3230
•
Kraft Foods,Inc.
Three Lakes Drive
Northfield, IL 60093
847-646-2000
 Lakeview Planetarium
1125 W. Lake Ave.
Peoria, IL 61614
309-686-6682
 L.C.N. Closers
121 W. Railroad Avenue
Princeton, IL 61356
815-875-3311

Lewiston CUSD #97
15501 E Avenue L.
Lewiston, IL 61542
309-547-2240
 Liventus
•
3400 Dundee Road
Northbrook, IL 60062
847-291-1395
Martin Engineering
One Martin Place
Neponset, IL 61345
309-852-2384
14
 Mary Kay Cosmetics, Independent Sales
LaHarpe, IL 61450
217-659-3070
 McDonough District Hospital
525 E. Grant
Macomb, IL 61455
309-833-4101
 MGM Studios
2450 Broadway Street
Santa Monica, CA 90404
310-449-3000/800-405-4646
•
Monmouth College
700 E. Broadway
Monmouth,IL 61462
309-457-2325
•
Motorola
1475 W. Shore Drive
Arlington Heights, IL 60004
847-632-2678
 Mundelein High School
1350 W. Hawley
Mundelein, IL 60060
847-949-2200
 Nelson Public School Dist. 8
PO. Box 880
RockFalls, IL 61071
815-251-4412

Neuromedical Services, Inc.
Practice Developers of IL, Inc.
7900 Cass Ave.
Darien, IL 60561
800-766-3870
 New Worlds Post Productions
5257 Shaw
St. Louis, MO 63110
314-367-1111
15
 NTN Bower
711 Bower Road
Macomb, IL 61455
309-837-0440
 Painted Imaginations
2933 N. Sheridan
Chicago, IL 60622
773-477-4092
 Palatine Dairy Queen
307 E. Northwest Highway
Palatine, IL 60067
847-934-0269
 Peerless Industries, Inc.
3215 W. North Avenue
Melrose Park, IL 60160
708-236-1000
•
Players Connection Inc.
Urban Centre One STE. 147
4830 W. Kennedy
Tampa, FL 33609
 Pleasant Paradise/Salon and Day Spa
4937 Butterfield Road
Hillside, IL 60162
708-449-7535
 Price Elementary School
4351 S. Drexel Blvd.
Chicago, IL 60653
773-535-1324
 Quad Cities Regional Program
UIC College of Nursing
1515 5th Avenue, Suite 400
Moline, Illinois 61265
309-757-9467
 Sourcebooks Inc.
1935 Brookdale Road Suite 139
Naperville, IL 60563
630-961-3900
16
 Southwest Montessori Preschool
8620 S. Racine
Chicago, IL 60620
773-224-5437

Spoon River College
23235 N County Hwy 22
Canton, IL 61520
309-647-4645
•
State Farm Insurance Companies
Three State Farm Plaza South
Bloomington, IL 61791-00-1
309-735-3157
 Syntax Media
25 330 River Oaks Dr.
Warrenville, IL 60555
630-393-4100
•
The How-To Network
4603 Atoll Avenue
Sherman Oaks, CA 91423
818-380-6612
 United States Army
Ft. Shafter
1557 Pass Street
Honolulu, HI and Bellows AFS
808-438-1600
 Wapello CSD
501 Buchanan
Wapello, IA 52653
319-527-1209
•
Western Illinois University
Admissions
115 Sherman Hall
Macomb, IL 61455-1390
309-298-3157
17
 Western Illinois University
Physical Education Dept.
Macomb, IL 61455
309-298-1981
 Western Illinois University
Tri-States Audio Information Services
University Services Building 504
Macomb, IL 61455
309-298-2403
 Western Illinois University
University Relations
302 Sherman Hall
Macomb, IL 61455
309-298-1993
•
Western Illinois University
Visual Production Center
Nonprint Production
418 Memorial Hall
Macomb, IL 61455-1390
309-298-1358
•
Western Illinois University
Western Courier
Heating Plant Annex
P.O. Box 6009
Macomb, IL 61455-1390
309-298-1876
 WHOI/WBPE TV
500 N. Stewart Street
Creve Coeur, IL 61610
309-698-1919
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Internship Forms
19
Department of Instructional Design and Technology
Western Illinois University
INTERNSHIP REQUEST and APPROVAL FORM
IDT 499
Name:
Date:
Semester/Year Internship Requested:
Number of semester hours requested: __________s.h.
List name and address of organization where you plan to do your internship:
______________________________________________________________________________________
Name of immediate supervisor at the organization: _____________________________________________
Attach to this request the following:
1.
2.
3.
4.
Description of the proposed organization for which you plan to intern. Attach fliers, advertisements, etc.
Describe the duties of the proposed immediate supervisor and how it relates to the organization.
Describe your proposed duties and objectives and how they relate to your immediate supervisor's job
functions and how they relate to your career goals.
Describe the duties that you will be performing and how these duties fit into the organization's long range
plans.
State any other considerations that might be a factor in the selection of your internship location (do you have
children, is the internship on/off campus, will you be getting paid?)
IDT Advisor's signature
Date
IDT Faculty signature
Date
Registered by:
Date:
Weekly Reports:
Mentor’s Min-term Report:
Mentor’s Final Evaluation:
Intern’s Evaluation and Final Report by:
20
INTERNSHIP WAIVER AND RELEASE
Department of Instructional Design and Technology
Western Illinois University
WHEREAS, the Board of Trustees of Western Illinois University on behalf of the Department of Instructional Design and
Technology, Macomb, Illinois, has entered into agreements with various institutions, companies, agencies and other entities who
have agreed to accept certain students in the Department of Instructional Design and Technology as interns with such entities for the
purpose of furthering the education of such students, and
WHEREAS, I have been accepted by
___________________________________________________________________________
(Name of Agency Accepting Intern)
as such an intern, and whereas, the internship training program will include using institutional equipment and participating in other
agency activities, as directed,
NOW THEREFORE, I hereby, in consideration of my acceptance as such an intern by the above named institution, company or
agency, and the effort of Western Illinois University in securing such placement, do release and waive any and all claims or demands
of whatsoever nature that I now have or may have in the future against the Board of Trustees of Western Illinois University, and
_____________________________________________________________________________
(Name of Agency Accepting Intern)
together with the officers, agents, servants and employees of Western Illinois University and the
_____________________________________________________________________________
(Name of Agency Accepting Intern)
resulting from my services such as intern.
I further covenant and agree, in consideration of my placement and acceptance as such intern, to indemnify and hold harmless the
Board of Trustees of Western Illinois University and ___________________________ _________________________________,
their officers, trustees, agents, and employees from any liability and/or lawsuits that may be incurred by them or either of them,
resulting from my acts during such internship.
I further represent that I am above the age of 21 years, with full understanding of all risks involved, and agree that this waiver and
release shall be binding upon my heirs, executors, administrators, and assignors.*
____________________________
Student Signature
____________________________
Witness Signature
21
INTERNSHIP STATEMENT OF INSURANCE COVERAGE
Board of Trustees of Western Illinois University
on behalf of
Department of Instructional Design and Technology
I, _____________________________, certify that I have paid for the Student Health and
(Student's Name)
Major Medical Program which is provided to Western Illinois University Students (or have
voluntarily waived University Insurance by providing, verifying, and maintaining an equivalent
policy through a private insurance representative) and that I will not cancel or change this
insurance coverage during the period of my Internship. I further represent that I am above the
age of 21 years,* with full understanding of all risk involved and agree that this "Statement of
Insurance" shall be binding upon my heirs, executors, administrators, and assignors.
_____________________________
Student Signature
______________________________
Witness Signature
* For persons under the age of 21, parental signature required:
_______________________________
Parental Signature
22
INTERNSHIP AGREEMENT
Board of Trustees of Western Illinois University
on behalf of
Department of Instructional Design and Technology
The internship in Instructional Design and Technology is designed to provide an opportunity for practical application of classroom
theory in a professional setting. The student should acquire experience in instructional design, technology applications, project
management and evaluation by working with an approved agency, company or institution under highly trained personnel in varied
settings. The student, the instructor, and the institution/company/agency/mentor involved in the internship experience will all share
in the responsibilities of the experience.
1. The student will spend no less than 200 hours in professional fieldwork for which s/he will receive 4 semester hours of credit. The
student is expected to follow the rules, regulations and policies of the institution/company/agency/mentor as if s/he is an employee.
2. The Department of Instructional Design and Technology will provide faculty advising and guidance to the intern. The intern will
prepare a statement that delineates the philosophy and objectives of the internship; the progression and scope of the internship; any
policies and procedures agreed to by the institution/company/agency/mentor, and any forms, records, or reports required for
submission by the IDT department.
3. The Department of Instructional Design and Technology and its legal entity The Board of Trustees of Western Illinois University
will provide the institution/company/agency/mentor with a Statement of Insurance and Waiver and Release Forms (attached).
4.
The student will likely participate in planning his program for the internship and will submit weekly reports to the
institution/company/agency/mentor
and
IDT
faculty
advisor;
have
periodic
conferences
with
the
institution/company/agency/mentor; and participate in the final evaluation of the internship.
5.
The institution/company/agency/mentor and the Department of Instructional Design and Technology will jointly agree upon
placement of a student at the institution/company/agency/mentor, after consultation with the student about the needs of the student
in relation to what the institution/company/agency/mentor can provide. The student will arrange for an interview, if necessary,
before a final decision is made. Upon selection of the institution/company/agency/mentor for placement, a general plan for the
student during the entire internship should be developed that reflects the student's goals and objectives for this experience.
6.
The internship should include multiple experiences with more than one facet of the institution/company/agency/mentor in order to
provide an understanding of the total scope of its instructional technology operations. For example, interns could be given
opportunities to plan, organize, and lead activities, as well as opportunities to observe and participate in other activities.
7. When necessary, the institution/company/agency/mentor may alter the above statements to make the requirements appropriate to the
institutional setting or to meet the individual student's needs. However, the Department of Instructional Design and Technology
must be notified of substantial changes.
-1-
23
Board of Trustees of Western Illinois University
on behalf of
Department of Instructional Design and Technology
and
______________________________________________________
(Agency)
______________________________________________________
(Agency Mentor/Supervisor)
________________________________________________________________________
Street
City
State Zip
Area Code/Phone
agree to the above statement for the following student: __________________________________
Beginning date: _________ Ending Date: __________
Signatures
_________________________________
(Student Signature)
Date: ________________
_________________________________
(IDT Faculty Advisor)
Date: ________________
_________________________________
(Agency Mentor)
Date: ________________
_________________________________
(IDT Chairperson)
Date: ________________
This form must be signed and returned to: Department of Instructional Design and Technology,
Western Illinois University, One University Circle, Macomb, IL 61455 before a student can begin his/her internship. If
accepted, the student will report to the institution or agency at a time designated. Fax: (309) 298-2978.
-224
Department of Instructional Design and Technology
IDT 499 - Internship
Weekly Activity Log
Name: ____________________________________________________________________________
Internship Location: _________________________________________________________________
Weekly Period Beginning/Ending: ___________________________________________________
Assigned duties during this period:
Goals and objectives progress:
Learning activities during this period:
Self appraisal of performance:
General comments regarding the internship experience:
__________________________________________ Intern’s Signature
__________________________________________ Mentor’s Signature
Department of Instructional Design and Technology
25
Department of Instructional Design and Technology
IDT 499 - Internship
Evaluation of Internship Experience by Intern
Name: _________________________________________ Date: __________________
Internship Location: _____________________________________________________
On-Site Mentor: ________________________________________________________
Signature of Intern: _______________________________________________________
Please mail to: Chairperson, Department of Instructional Design and Technology, 47 Horrabin Hall,
1 University Circle, Macomb, IL 61455
26
Department of Instructional Design and Technology
IDT 499 - Internship
Evaluation of Internship Experience by Intern
Name: _________________________________________ Date: __________________
Internship Location: _____________________________________________________
On-Site Mentor: ________________________________________________________
Please comment at this time on the progress of the inernship in the following areas:
The inter’s progress toward the agreed-upon objectives for the internship:
The intern’s professionalism and overall work habits:
The intern’s overall strengths and weaknesses:
Any other matters that you would like to bring to the interns or faculty advisor’s attention:
Please mail to: Chairperson, Department of Instructional Design and Technology, 47 Horrabin Hall,
1 University Circle, Macomb, IL 61455
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Department of Instructional Design and Technology
IDT 499 - Internship
On-Site Mentor Final Evaluation of Intern
Name of Intern: ____________________________________________________________________
Internship Location: _________________________________________________________________
Name of Mentor: __________________________________________ Date: ___________________
Please check only one box in each category:
RESPONSIBILITY
QUALITY OF WORK
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Deliberately avoids responsibility
Reluctantly accepts responsibility
Accepts responsibility well
Readily accepts duties
Actively seeks new responsibilities
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Very Poor
Below average
Average
Very good
Excellent
ATTITUDE-APPLICATION TO WORK
WRITTEN COMMUNICATION
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Definitely not interested
Somewhat indifferent
Average in diligence and interest
Very interested and industrious
Outstanding in enthusiasm
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Vague, disorganized
Not what is expected of a college graduate
Average expression
Concise, factual, effective
Outstanding
INITIATIVE
DEPENDABILITY
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Must be pushed frequently
Hesitates
Does all assigned work
Goes ahead independently at times
Proceeds well on ones own
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Unreliable
Sometimes neglectful or careless
Usually dependable
Above average in dependability
Completely dependable
ORAL COMMUNICATIONS
RELATIONS WITH OTHERS
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Poorly conveys ideas
Sometimes ambiguous
Average expression
Clearly communicates ideas
Very articulate
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Works poorly with others
Has difficulty working with others
Gets along satisfactorily
Works well with others
Exceptionally well accepted
ABILITY TO LEARN
MATURITY - POISE
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Very slow to learn
Rather slow in learning
Average in understanding work
Learned work readily
Learned work exceptionally well
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)
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Timid
( ) Brash
Seldom asserts his/herself
Average maturity and poise
Has good self-assurance
Quite poised and confident
QUANTITY OF WORK
KNOWLEDGE
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Low output, slow
Below average
Normal amount
More than average
Usually high output
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Lacking in even the basic fundamentals
Now what is expected of a college graduate
Average
In tune with operations
Outstanding
JUDGMENT
ATTENDANCE
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( ) Regular
( ) Irregular
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Consistently uses bad judgment
Often uses poor judgment
Average judgment
Usually makes the right decisions
Exceptionally mature in judgment
PUNCTUALITY
( ) Regular
( ) Irregular
OVERALL PERFORMANCE
1
2
Outstanding
Very Good
3
Average
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Marginal
5
Unsatisfactory
The Intern’s outstanding personal qualities are:
The personal qualities that the intern should strive most to improve are:
The recommended areas of further study for the intern are:
Additional remarks:
Has this report been discussed with the student? ( ) yes
( ) no
Signature: ______________________________________ Printed Name: _______________________
Position: _______________________________________ Date: ______________________________
Please return to: Chairperson, Department of Instructional Design and Technology, 47 Horrabin Hall,
1 University Circle, Macomb, IL 61455
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