Internship Documents

Complete the required entries and upload documents in the areas specified below.

Intern Name: *

Texas State E-mail Address: *

Phone number: *

Internship Professor Last Name: *

Degree Track: *

Semester for which you are submitting Internship Documents: *

Year of Internship Semester: *

This will be my __ semester of Internship: *

Required Internship Documents

Provide scanned copies or pictures of the required documents here.

Attach a copy of your Liability Insurance in effect for the duration of the semester

Attach a copy of your Finalized Memorandum of Agreement signed by all parties

Attach a copy of the Proposed Activity Plan

Attach a copy of the Supervisor Disclosure Statement

Attach a copy of the Mid-Semester Evaluation of Intern

Attach a copy of the Intern Activity Sheet signed by Intern and Supervisor

Attach a copy of the Final Log signed by Supervisor

Attach a copy of the Site Supervisor Evaluation of Intern

Attach a copy of the Intern Evaluation of Site

Attach a copy of the Student Evaluation of Site Supervisor form

Internship Site and Supervisor Information

Complete the following information:

Name of agency:

Agency address:

Agency phone:

Site supervisor’s name & credentials:

Site supervisor’s e-mail address:

Site Supervisors must hold one of the following credentials. [Board approved supervisor status is not required.] Specify which credential your Site supervisor currently holds:

Additional information:

If you are completing internship hours at multiple sites, submit this set of documents using the button below. On the “Thank You for Your Submission” page, you can use the provided buttons to return to the Site Based Internship webpage or go directly to the Internships Documents page to complete another submission.

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