SAA 781 - INTERNSHIP FORM
STUDENT NAME:
STUDENT IS ENROLLED IN: _____On-Campus program _____ Online program _____ UWRF program
Notes:
 The internship is a 3-credit experience, which includes 140 hrs of field experience plus online course activities.
 The internship experience must take place during the semester that the student is enrolled for the internship credits (SAA 781)
 SAA 781 is graded on a pass/fail basis.
 Please check all of the following ACPA/NASPA competencies that will be a focus in the internship:
☐Personal and Ethical Foundations
☐Values, Philosophy, and History
☐Assessment, Evaluation, and Research
☐Law, Policy, and Governance
☐Organizational and Human Resource
☐Leadership
☐Social Justice and Inclusion
☐Student Learning and Development
☐Technology
☐Advising and Supporting
 Students in the On-campus and UWRF program should work with their site supervisor to complete this form and submit to course
instructor, per deadline indicated in course syllabus.
SUPERVISOR (Name, Email & Phone Number):_______________________________________________
INTERNSHIP SITE (Dept./Institution):_____________________________________________________________________________________
START DATE:
COMPLETION DATE:
1
POSITION DESCRIPTION:
GOALS:
LEARNING OUTCOMES:
2
PROPOSED EVALUATION/ASSESSMENT PLAN:
The SAA 781 instructor will work with the site supervisor and student regarding evaluation and assessment processes.
3