APPLICATION FOR INTERNSHIP / ADVANCED FIELDWORK
in THERAPEUTIC RECREATION
Name:
Student ID:
Date:
Overall GPA:
Local Address
Street:
City, State, Zip:
Phone:
E-mail:
Academic Information
Semester/Year in Which You Plan to Graduate:
Semester in which you plan to Intern/Fieldwork:
Name of Your Academic Advisor:
Major:
Minor (if applicable):
Therapeutic Recreation
Participation in the internship program is limited to qualified students. To qualify, a student should have
completed the required courses listed below and earned a cumulative grade point average of 2.5 in these
courses. An average grade of B must also have been earned in Fieldwork courses. No student on academic
warning may apply for internship. Students who do not meet the above requirements must enroll in
Advanced Fieldwork.
Section I
Directions: On the next page is a list of the required Courses in your major. For each course listed, check
the appropriate box indicating whether you have taken or are currently registered for the course. In addition,
list any additional courses that you have taken that have a RLS- prefix. Lastly, you will need to download the
GPA calculator spreadsheet (http://www.ithaca.edu/oel/trls/tr.htm) and fill in the grade that you obtained in
each course that you have completed. After entering your grades, print a copy of the document and attach it
to this application. Applications will not be accepted without a copy of this information included.
Required Recreation and Leisure Studies Courses
Status
Course (Required RLS-prefix theory courses and other courses in
(check one)
your major as appropriate)
Taken
Registered
History and Philosophy of Leisure RLS 10300
Fundamentals of Leadership RLS 10500
Understanding Disability RLS 12500
Computer course (if needed) COMP 11000 or HLTH 13901
Program Planning RLS 23200
Design and Operation RLS 23500
Service Learning I RLS 24800
Administration of Recreation RLS 33000
Research Methods RLS 33200
Service Learning II RLS 34800
Seminar: Professional Development RLS 45300
Introduction to Therapeutic Recreation RLS 23300
Interventions and Protocols in TR RLS 24300
Inclusive Recreation and Diversity RLS 34000
Leisure Education RLS 33400
Therapeutic Recreation Process I RLS 35000
Therapeutic Recreation Process II RLS 36000
Administration of TR RLS 43300
Anatomy & Physiology I- EXSS 12000
Anatomy & Physiology II- EXSS 12100
Developmental Psychology PSYC 10400
Abnormal Psychology PSYC 32100
Clinical Applications in TR RLS 35300 (Fall)
Clinical Applications in TR RLS 35000 (Spring)
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Section II
List below any specific agencies which you are considering or investigating.
Signature
I give my advisor, internship coordinator and internship supervisor permission to discuss my academic
performance and professional behavior with agency representatives.
Student Signature
Date
When completed, this form must be submitted to the Therapeutic Recreation Internship Coordinator along
with a personal resume containing your work/volunteer experience, extracurricular activities,
honors/recognitions, and active memberships in professionally related organizations.
***************************************************************
For Office use only
Date Application Received:______________
Dept. Chair, RLS
Internship Coordinator
Date
Date
 Application Approved
based on the completion of the following requirements




Maintenance of a 2.0 Overall GPA
Maintenance of a 2.5 GPA in RLS-XXXXX Courses
Completion of Service Learning I and II with a B average or better
Other Requirements ___________________________________________________
 Application Denied
Explanation:
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