Student Acknowledgement of RHS Pre-Internship Responsibilities (Appendix B)

This statement acknowledges that:

  1. I have reviewed my audit with my academic adviser and, with exception of internship, have completed all degree requirements. I understand it is my responsibility to register my intent to graduate on eLion within the first two weeks of the semester I am completing internship.
  2. I understand that in the event that I do not satisfactorily complete courses the semester prior to internship, I will not be able to begin internship. It is my responsibility to notify the Internship Coordinator and Site Supervisor if this situation occurs. Any deficiency must be satisfactorily completed before I begin internship.
  3. I have submitted the following materials as part of my Internship Application:
    Internship Scheduling Sheet (Appendix A)
    • Typed statement of internship job duties/job description
    • List of at least four goals and objectives to accomplish during internship
    • Current resume
    • Current degree audit showing all course requirements have been met
  4. I have learned from my agency/facility Site Supervisor or representative whether the following forms are needed, at least 60 days prior to the internship starting date:
    • Child Abuse Background Check form (Act 151 Clearance)
    • Criminal Background Check form (Act 34 Clearance)
    • Malpractice insurance form
  5. If any forms noted in #4 are required, I verify that I have completed all necessary paperwork.
  6. I have received assurance from the prospective Site Supervisor that this person has a minimum of a bachelor's degree and, at least two years of experience in the field for which I am seeking training.

This signed and dated form must accompany the Internship Application. I am aware that failure to submit all necessary documentation by the required deadline could result in a delay in starting internship, which could affect graduation. I am also aware that submitting the Internship Application after the deadline will result in one letter grade deduction from my final grade.

My signature on a printed version (pdf) of this page attests that I have read and understand this information.