DEPARTMENT OF KINESIOLOGY & RECREATION
HEALTH FITNESS INTERNSHIP
APPLICATION
Name__________________________________Birth Date______________________
Mailing address __________________________________________________________
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Permanent Address _______________________________________________________
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Telephone _______________________________________________________________
Major: __________________________________________________________________
Expected Graduation Date_________________
Grade Point Average (major)____________ Grade Point Average (overall)___________
Total Semester Hours Completed_________
College Advisor__________________________________________________________
Car: ( ) yes ( ) no
What professional clubs or organizations are you currently a member of?
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What offices have you held and what honors have you received in high school and
college?
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What job experiences relate to your internship placement?
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What would you like to accomplish during your internship? List goals and
objectives.
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List your strengths and weaknesses as you presently perceive them related to
completing an internship.
STRENGTHS___________________________________________________________________________________
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WEAKNESSES_________________________________________________________________________________
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Give a brief biographical sketch. Include what influenced and motivated you to
pursue this career path. Explain what contributions you can make to the
Health/Fitness field. Why did you choose the Health/Fitness concentration?
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Define professionalism and teamwork. How does this relate to your philosophy of
Health/Fitness?
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List three different topic areas for a special project.
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Attach a copy of your professional resume and your course audit to this
application form detailing all courses and grades received for those courses
throughout your college career. This course audit can be obtained from your
advisor or the registrar.
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DEPARTMENT OF KINESIOLOGY & RECREATION
HEALTH FITNESS INTERNSHIP
CONTACT INFORMATION
Students: Print out 2 copies of this form, complete the information, & sign the contract after discussion
with your potential supervisor. Give one copy to your supervisor at your chosen site. Return one to your
instructor at FSU by May 1, 2015.
Student Name: __________________________________________________________________ GPA: _______________________
Phone number: ________________________________________________ Class standing: _____________________________
E-mail address: ________________________________________________________________________________________________
When I graduate from FSU, I want to: ______________________________________________________________________
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Previous FE placements: _____________________________________________________________________________________
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Site Name: ______________________________________________________________________________________________________
Address: _________________________________________________________________________________________________________
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Phone Number: ________________________________________________________________________________________________
Supervisor’s Name: ____________________________________________________________________________________________
E-mail: ___________________________________________________________________________________________________________
Phone Number: ________________________________________________________________________________________________
Description of the Facility: ___________________________________________________________________________________
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Your role at that facility as a student: ______________________________________________________________________
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Student Signature: _____________________________________________________________________________________________
Supervisor Signature: _________________________________________________________________________________________
Date: ______________________________
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DEPARTMENT OF KINESIOLOGY & RECREATION
HEALTH FITNESS INTERNSHIP
COOPERATING SITE AGREEMENT & CONTRACT
The purpose of the internship is to provide a means for applying theoretical
concepts learned in the undergraduate Exercise & Sport Science Curriculum to a practical
situation. This experience is an opportunity for the student to learn to effectively deliver
health and fitness concepts to target populations. During this experience the student will
have the opportunity to experience and enhance their knowledge of health & fitness, but
also to learn about the business aspect of health & fitness management. The supervising
internship site plays a vital role in the professional preparation of the intern. Frequently,
the internship site is the student’s first exposure to the professional world. In order to
ensure a quality experience for both the student-intern and for the supervising internship
site expectations and responsibilities will be outlined for all participating persons.
STUDENT INTERN RESPONSIBILITIES
During their professional placement in an internship facility, the student intern will be
responsible for fulfilling the following requirements:
(1) The intern must complete a minimum of 45 hours on the job for each credit
that they are registered for. This will equal 405 total hours, or approximately 30
hours per week during a typical semester. All hours must be logged and then
verified by the direct supervisor.
(2) The intern must keep a daily log of all activities that will be handed into the
program coordinator following the internship. This log should include specific
assignments and activities carried out each day of the internship.
(3) The intern must fulfill all internship basic requirements (i.e. special projects,
fitness testing, program development, special populations).
(4) The intern must inform the program coordinator as to the scheduled workdays.
(5) The intern must contact the program coordinator several times throughout the
field experience to report your progress as well as any difficulties that they are
experiencing.
(6) During the Internship experience the HFF student will be required to complete
several projects designed to enhance their educational experience. These projects
will be kept in a student portfolio and must include:
 A promotional project / marketing plan for the internship facility.
 An individual fitness program.
 A group fitness / wellness program (i.e. an exercise class, educational
seminar, or team program).
 A fitness-testing portfolio.
 A summary reflection paper.
Additionally, the student-intern will be required to obtain 5 practical hours in each of the
following domains:
 Senior Citizen Wellness
 Obesity/Weight-Control
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RESPONSIBILITIES OF THE SPONSORING INTERNSHIP SITE
The supervising internship site shall provide the FSU Exercise & Sport Science
Intern with the opportunity and available health/fitness equipment, physical facilities,
materials and supplies in which to apply and practice the clinical skills related to that
intern’s field of study. The sponsoring internship site will also provide each Exercise &
Sport Science Intern with the opportunity to work with that facility’s clientele as
appropriate. The supervising facility will have the responsibility to provide the Intern
with the appropriate equipment and opportunity to fulfill all internship basic requirements
(i.e. special projects, fitness testing, program development, special populations), as well
as to designate the administrative daily activities. Furthermore, the supervising facility
will have the right to remove any Intern with whom they become dissatisfied and shall be
relieved of any obligations to the Intern. In the event that any supervising facility’s
physical facilities are deemed unsuitable for an appropriate learning experience by the
Intern’s faculty supervisor, the Intern may be removed from that site and placed in an
appropriate internship site. The supervising internship site also agrees to complete a
midterm and final evaluation form and submit these evaluations to the faculty internship
supervisor within one (1) week of the completion of the internship experience.
Each supervising internship site must provide the following items to ensure
appropriate practice of clinical skills by the intern:
(1) Body composition testing equipment (i.e.: skin fold calipers, BIA device, BodPod, Hydrostatic weighing, Futrex, or any other appropriate device).
(2) Cardiovascular Fitness Testing Equipment (i.e.: Lifecycle Fit-Test, YMCA
Sub-Max Cardio Test, Harvard Step-Test, or any other appropriate testing protocol).
(3) Musculoskeletal Flexibility testing equipment (i.e.: Tape measure, sit & reach
box, goniometer, or any other appropriate testing device).
(4) Standard Sphygmomanometer & Stethoscope.
The Exercise & Sport Science Intern will conduct a facility review during the first
week of the internship at their respective internship site. A checklist of the
aforementioned facility requirements will be taken. If any deficiencies in the required
facilities are noted in this review, the faculty internship supervisor will personally review
the facility. From this facility review, the faculty supervisor will make a written report of
the deficiencies. The Internship site will have fourteen (14) days to correct the
deficiencies or the intern will be placed in a new internship site.
The supervising internship facility will continue to have responsibility and
liability for supervision of the facility’s daily operations, exercise equipment, physical
facilities, material and supplies which it provides for the use and application of the
Exercise & Sport Science Interns. Additionally, the supervising internship facility will
agree to assign only duties consistent with the job description of a regularly employed
health/fitness professional.
COMPENSATION
In compliance with the Department of Labor’s requirements, Exercise & Sport
Science Interns will receive nine (9) hours of academic credit for their participation in
this internship experience. Therefore, the supervising internship facility is NOT required
to financially compensate the intern for services provided. If financial compensation is to
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be rewarded it is the responsibility of the Intern and the supervising internship facility to
determine the appropriate pay scale and schedule.
TERM
The effective date of this agreement shall be ________. This agreement shall terminate
on ____________. The parties agree to discuss renewal of this agreement sixty (60) days
prior to termination.
PROFESSIONAL LIABILITY INSURANCE
Each student intern shall be required to obtain a professional liability insurance policy
with coverage limits of not less than $1 million per claim and $3 million aggregate, with
the policy being written on an occurrence basis and subject to annual renewal. Each
Intern must present written proof of such insurance to the supervising faculty member
and the internship supervisor prior to the intern’s first on-site visit to the sponsoring
internship site.
NONDISCRIMINATION
Each party agrees that student recruitment, admission, participation in clinical activities,
and evaluation shall occur without discrimination with respect to race, color, creed,
sexual orientation, age, disability, or national origin.
GOVERNING LAWS
This agreement shall be governed by the laws of the State of Maryland, and subject to the
exclusive jurisdiction of Maryland State courts.
AMENDMENTS
This agreement may be amended only in writing and signed by each of the parties to this
agreement.
IN WITNESS WHEREOF, the parties, by their authorized officials, execute this
agreement for Exercise & Sport Science Health/Fitness Internship.
SPONSORING INTERNSHIP SITE
Name of Sponsoring Site:___________________________________________________
Authorized Official: (print)__________________________________________________
Authorized Official: (signature)_______________________________Date:___________
FROSTBURG STATE UNIVERSITY
Internship Faculty Supervisor: (print)__________________________________________
Internship Faculty Supervisor: (signature)__________________________Date: _______