Therapeutic Recreation Major
Internship Requirements Checklist
Instructions to the Student: Please type this form. Enter due dates for assignments under the Due column based
on your internship start and end dates. Due dates may be set 1-2 days after your workweek, to provide time to
complete assignments. Submit this form to the Internship Coordinator and retain a copy for your reference.
Student Name:
Phone Number:
Agency:
Supervisor Name:
Start Date:
Midpoint Date:
Requirement
Internship Requirements Checklist
End Date:
Due
Received
Before internship
_______
Grade/Points
N/A
NOTE: Page numbers refer to the TR Internship Manual.
Initial Information and Schedule (due by end of Week 1)
Student Information Form (p. 12)
Internship Work Schedule (p. 12)
Learning Objectives (p. 12)
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______ /5 pts.
Bi-Weekly Reports & Daily Logs (pp. 12-13)
Biweekly Report and Log #1: Week 2
Biweekly Report and Log #2: Week 4
Biweekly Report and Log #3: Week 6
Biweekly Report and Log #4: Week 8
Biweekly Report and Log #5: Week 10
Biweekly Report and Log #6: Week 12
Biweekly Report and Log #7: Week 14 (if needed)
Biweekly Report and Log #8: Week 16 (if needed)
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______ /10 pts.
______ /10 pts.
______ /10 pts.
______ /10 pts.
______ /10 pts.
______ /10 pts.
______ /10 pts.
______ /10 pts.
Midterm Evaluation (due at midpoint)
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______ /5 pts.
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______ /15 pts.
______ /5 pts.
______ /10 pts.
Due one week after concluding the internship:
Final Evaluation Report and Log (p. 14)
Final Evaluation
Special Project Report (p. 14)
Final Grade from Agency Supervisor
Final Grade from Faculty Supervisor
Final Internship Grade*
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______
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* If the internship extends beyond the summer/semester deadline for faculty to submit a final grade, a grade of
Incomplete (“I”) will be recorded. When the student has completed all internship requirements, the “I” will
be changed to a letter grade.
Site Visit Date (if applicable): _________________________________________