Frostburg State University



Frostburg State UniversityExercise & Sport Science 16002003153410Internship Packet00Internship Packet2171700532511000-11430037249100049149003839210004800600212471000114300189611000240030075311000Table of ContentsIntroductionp. 3Guidelines for Internship Experiencep. 4Internship Assignment Sheetp. 7Requirements for the Promotional Project/Marketing Planp. 9Requirements for the Individual Fitness Programp. 12Requirements for the Group Programp. 13Requirements for Testing Portfoliop. 15Grading of Field Experiencep. 16Time-Linep. 22Appendix I: Health Fitness Internship Applicationp. 28Appendix II: Student Evaluation: Mid-Termp. 23Appendix III: Student Evaluation: Finalp. 30Appendix IV: Sample Daily Journal Formp. 32Appendix V: Internship Site Articulation Agreement / Contractp. 35Frostburg State UniversityExercise & Sport ScienceInternship ExperienceEXSS 495: 9 CreditsIntroductionThe 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 you to learn to effectively deliver health and fitness concepts to target populations. During this experience you will have the opportunity to enhance your knowledge of health and fitness, but also to learn about the business aspect of health and fitness management.During the internship you should think of yourself as a professional. You are representing yourself as well as Frostburg State University. You will get out of this experience as much as you put into it. Remember that internship experiences can, (and often do) lead to future employment.Guidelines For EXSS Internship ExperiencePrior to Internship:(1) All potential interns must register for EXSS 495 for 9 credits and EXSS 492 for 3 credits.(2) All potential interns must hand in a list of a minimum of three potential sites where they would like to do their internship ONE SEMESTER PRIOR TO THE INTERNSHIP EXPERIENCE! The internship coordinator in cooperation with the student intern will make the final decision as to where the student will be placed.(3) The APPLICATION FORMS must be completed and handed in to the coordinator___________________________________ two (2) months prior to the internship experience.(4) All course work in the health/fitness concentration must be completed. You must print a copy of PAWS ACADEMIC AUDIT form and submit it with application. This requirement is to ensure that you have all necessary knowledge, skills, and abilities to successfully complete all required duties during your experience.(5) You must become a student member in a health/fitness related professional organization. Please select from the following: You are required to provide evidence of membership (i.e. membership card) prior to beginning your internshipNational Strength & Conditioning Association (NSCA)nsca-American College of Sports Medicine (ACSM)American Council on Exercise (ACE)Aerobic & Fitness Association of America (AFAA)(6) You MUST obtain professional liability insurance prior to beginning your internship experience. This insurance will be provided free of charge through Frostburg State University. You must submit your internship application by the due date (see the internship time-line) to allow for adequate processing time for your policy. Failure to submit your application in a timely manner will result in you being de-registered from EXSS 495.(7) You must purchase a current copy of the ACSM’s Guidelines For Exercise Testing and Prescription.(8) You must contact the internship site and arrange for an intake interview with the supervising staff member(s). You should provide the facility with a current resume as well as a list of your personal goals and expectations from this experience. You should also provide the internship site’s supervising staff member(s) with a copy of your Evaluation & Prescription (EXSS 411) Exercise Testing Portfolio.(8) You must provide the internship-site with a copy of the articulation agreement / contract (Appendix V). This agreement MUST be completed and returned to the following address PRIOR to beginning the internship experience. Failure to complete and return this agreement in a timely manner will result in you being de-registered from your internship course!Return contract to your advisor: John Wright, Hunter Brakeall, Michele Bennett, or Melody KentrusEvidence verifying that all of the above requirements have been met MUST be presented to the EXSS 495 FACULTY no later than the specified deadline during the semester prior to the internship experience (unless otherwise specified). Failure to fulfill all minimum requirements will result in the student NOT being allowed to participate in the Internship experience for that semester.Internship Requirements:You must complete a minimum of 45 hours on the job for each credit that you 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 your direct supervisor.You must keep a daily log of all activities that will be handed into the internship coordinator following the internship. This log should include specific assignments and activities carried out each day of the internship.You must fulfill all internship basic requirements (i.e. special projects, fitness testing, program development, special populations). See “Internship Assignment” sheet.You must inform EXSS 495 FACULTY as to your scheduled workdays. You must submit prior to beginning your experience a proposed work schedule to the EXSS 495 FACULTY.You MUST contact the EXSS 495 FACULTY at least once per week throughout the internship to report your progress as well as any difficulties that you are experiencing. The preferred method of contact is via e-mail through the FSU system unless otherwise noted.Post-Internship Requirements:(1) You must meet with the EXSS 495 FACULTY to discuss your internship. All materials required for completion of the internship must be turned in to the EXSS 495 FACULTY immediately following the internship. This includes:Professional ResumeEvidence of membership in a professional organizationEvidence of personal liability insuranceDaily LogBusiness PlanPromotional Project / Marketing PlanIndividual Fitness ProgramGroup Fitness/Wellness ProgramTesting PortfolioSummary reflection paper.All materials must be organized in a professional portfolio.Internship Assignment SheetThe internship experience is graded Pass /Fail. In order to obtain a passing grade a minimum score of 70% must be earned during the internship.During the Internship experience the 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 business plan.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. Grade Components:Daily Log:5%A comprehensive account of what you did during your hours of duty should be recorded in this log. You must use the supplied internship daily log forms (appendix IV) for documenting all hours and activities. Failure to provide a complete journal will result in failure of the internship.You must have your supervisor sign-off on your daily journal every day to verify completion of daily responsibilities.If you are missing hours, you will be docked 1% on your final grade for each hour that is missing from your internship daily log.See grading rubric for more information.Projects:Group Project & Marketing Plan20%Individual Fitness Program30%Fitness Testing Portfolio20%See individual requirements on following pages and grading rubric for more informationEvaluation Forms5%Evaluation forms completed by the internship site supervising staff member should be sent to the student’s internship faculty instructor at mid-term of the internship and immediately following the internship. Students must score 70% or better on the supervisor’s evaluation to pass the course. Mid-Term evaluation formFinal Evaluation formFaculty Evaluation & Discussion ForumsSee grading rubric for more information.This evaluation will be based on the material handed in by the intern and a total evaluation of the entire experience. It includes your participation in weekly discussion forums on Canvas as well as your weekly communication with your internship coordinator/FSU instructor.Prior to Internship5%During Internship5%After Internship10%Includes Summary / Reflection PaperAn evaluation paper detailing your experiences on the job should include the following:What did you accomplish during the internship?What do you see as your strengths and weaknesses in this field?Were there any educational weaknesses in your Exercise & Sport Science major which hindered your performance in this internship? Please be very specific in detailing both strengths and weaknesses.Your suggestions for improving your education leading up to this internship and for improving this particular program.If you are unable to complete your internship due to events out of your control (i.e. the company goes out of business, layoffs, budget-cuts, act of God, etc.), you must contact the EXSS 495 FACULTY immediately to arrange for alternative internship opportunities. All possible efforts will be made to place you in a new internship site as quickly as possible. If this is not possible, then you will be graded based on the work that you have completed up to the point of termination.In the event of you being “fired” from your internship due to unprofessional behavior, rules violations, or criminal activity, you will receive a grade of “Fail” for your internship experience. Appeals will be granted to allow you to present your side of the story as well as any evidence that you may have in your defense.* See “Grading of Internship” form for specific criteria.Requirements for the Promotional Project/Marketing PlanAs a health fitness professional you will be expected to effectively design programs and then MARKET your program to attract potential participants. Marketing of your program will involve performing a brief feasibility study, determine your target population, contacting your target population, budgeting and determining successful and cost-effective means of advertising your program.It will be your responsibility to market your group wellness activity in order to attract participants. You will be responsible for working with your internship facility’s marketing/advertising department to develop and implement a successful marketing strategy. Develop a marketing plan for the business by answering these questions. If you are working at a franchise facility (Gold’s Gym, World Gym, Bally’s, etc.) you will have to use the marketing strategy the franchiser has developed. Your marketing plan should be included in your business plan and contain answers to the questions outlined below. 1. Description of business – Services? Products? Size of business? 2. Who are your customers? Define your target market(s).3. Are your markets growing? steady? declining? 4. Is your market share growing? steady? declining? 5. If a franchise, how is your market segmented? 6. Are your markets large enough to expand? 7. How will you attract, hold, increase your market share? If a franchise, will the franchiser provide assistance in this area? Based on the franchiser's strategy? How will you promote your sales?8. What pricing strategy have you devised? MARKETING PLANThis is the marketing plan of____________________________ I. MARKET ANALYSISA. Target Market - Who are the customers? 1. We will be selling primarily to (check all that apply): Total Percent of Business a. Private sector _______ ______ b. Wholesalers _______ ______ c. Retailers _______ ______ d. Government _______ ______ e. Other _______ ______2. We will be targeting customers by: a. Product line/services. We will target specific lines ________________ b. Geographic area? Which areas? ________________ c. Sales? We will target sales of ________________ d. Industry? Our target industry is ________________ e. Other? ________________ 3. How much will our selected market spend on our type of product or service this coming year? $________________B. Competition1. Who are our competitors? NAME ________________________________________ ADDRESS _________________________________________ _________________________________________ Years in Business ___________________ Market Share ___________________ Price/Strategy ___________________ Product/Service Features ___________________NAME _________________________________________ ADDRESS _________________________________________ _________________________________________ Years in Business ____________________ Market Share ____________________ Price/Strategy ____________________ Product/Service Features ____________________ 2. How competitive is the market? High ____________________ Medium ____________________ Low ____________________3. List below your strengths and weaknesses compared to your competition (consider such areas as location, size of resources, reputation, services, personnel, etc.): Strengths Weaknesses1._______________________ 1._____________________ 2._______________________ 2._____________________ 3._______________________ 3._____________________ 4._______________________ 4._____________________C. Environment1. The following are some important economic factors that will affect our product or service (such as trade area growth, industry health, economic trends, taxes, rising energy prices, etc.): ________________________________________________ ________________________________________________ ________________________________________________ 2. The following are some important legal factors that will affect our market: ________________________________________________ ________________________________________________ ________________________________________________ 3. The following are some important government factors: ________________________________________________ ________________________________________________ ________________________________________________ 4. The following are other environmental factors that will affect our market, but over which we have no control: ________________________________________________ ________________________________________________ -34290082549I attest that the student-intern completed this marketing analysis with the assistance of the General Manager / Marketing Coordinator / Fitness Director / Business Manager (or other acceptable personnel). Internship Site Supervisor’s Signature:_______________________________________________00I attest that the student-intern completed this marketing analysis with the assistance of the General Manager / Marketing Coordinator / Fitness Director / Business Manager (or other acceptable personnel). Internship Site Supervisor’s Signature:_______________________________________________Requirements for the Individual Fitness ProgramApplying accumulated knowledge and developing an effective fitness program for an individual is the cornerstone to a Health Fitness Instructor’s career. After completing the core curriculum of the Health Fitness concentration you will have the knowledge, skills, and abilities to effectively assess, evaluate, and prescribe a comprehensive fitness program for a variety of individuals. This project will allow you the opportunity to demonstrate your skill as a fitness professional by designing a personal fitness program for a facility member and serving as their “personal trainer” for the duration of your internship.Requirements for successful completion of the Individualized Fitness Program are as follows:Assessment SectionComprehensive wellness / health assessment Body composition analysisMusculoskeletal Flexibility AssessmentCardiovascular Fitness AssessmentBlood Pressure Measurement and assessmentMusculoskeletal strength assessment for ALL exercises performed.Diet Analysis using Dine Healthy, Cengage Learning, Diet Analysis, or other approved softwareDesign SectionNeeds analysisBiomechanical analysisBioenergeticsInjury analysis Other factors (previous injuries, etc.)Goal Assessment1-RM Predictions (all strength exercises)Periodization Model- with dates, starting ASAP while you are there with the clientMetabolic Equations / Heart-rate predictions (cardiovascular exercise)Fitness Program SectionStrength Program: 1 macrocycle (one year)Cardiovascular Program: (one year)Flexibility programNutrition / weight-loss programRequirements for the Group ProgramHealth fitness professionals are frequently required to design and lead group wellness activities. These activities range in scope from simple aerobics classes to smoking cessation or diabetes management programs. It will therefore be your responsibility to design and implement a comprehensive group activity within the context of your sponsoring facility. The topic for this program should be decided between your facility supervisor and yourself. Suggested topics for this group intervention are as follows:Diabetes managementSmoking CessationHypertension ManagementExercise for chronic pain / fibromyalgiaPre/Post natal exerciseSenior fitnessOsteoporosis preventionYouth / Adolescent FitnessTraining for CompetitionGroup CyclingProgressive relaxationYogaMartial ArtsSport Specific TrainingAdventure trainingWater ExerciseFlexibility TrainingRequirements for Testing PortfolioTo ensure that you have an opportunity to adequately practice your fitness component testing, you will be required to complete a fitness-testing portfolio during your internship experience. The required components of this portfolio are as follows:Health Risk Appraisal (PAR-Q and informed consent): 30Body Composition Tests: 100Skin-fold: at least 50Any combination of the following tests: Infrared (futrex), BIA, Hydrostatic weighing, Bod-Pod.Musculoskeletal flexibility: 50 totalSit & ReachApley’s Scratch TestGoniometryStrength Tests:Predicted 1-RM: 25Actual 1-RM: 25Blood Pressure: 100Cardiovascular Tests (must include informed consent for each participant): 30YMCA Cycle TestStep TestLifecycle Fit Test: (Must be completed w/ exercise B.P.)Your final portfolio:Should be in a 3-ring binder or book with a professional coil binding, including labeled tabs for each section.It must be submitted in the order as is laid out on the grading sheet. Everything should be typed with the exception of field work such as the daily journal and testing portfolio with signatures. Horizontal pages should be facing the same direction, outward. You only should have one page per sleeve, visible front and back, not multiple pages that need to be removed. Points will be deducted from each assignment if they do not have proper sentencing and grammar with appropriate citations.Keep in mind that you shouldn’t be working on writing or putting together your portfolio during internship hours. The internship hours are for learning and observing with your supervisor and clients. The portfolio should be written and put together on your own time. For all paperwork, you may use forms that your site uses, or you may create your own forms. You should NOT be using FSU’s class forms. The standard EXSS late policy is in effect unless otherwise noted (in the case of faculty approvals). All assignments are expected to be turned in on time in a neat and professional format. They are to be typed, unless otherwise noted, as in the case of signatures or work that was completed in the field. Late submissions for the individual project, midterm, and for the final portfolio in general, will be docked 10% each day they are late for up to 7 days. This means that if a student hands in the assignment any time that same day after the deadline, even if it is 5 minutes late, he will lose 10% of the grade on that assignment. If the project is handed in the next day, he will lose 20%. If the project is handed in the following day after that, he will lose 30%. After 7 days, late assignments will not be accepted. Due dates:Approval of group project/marketing plan and individual fitness program: Wednesday at noon of Week 3Midterm evaluation and completed individual fitness program: Wednesday at noon of Week 6Final evaluation and final portfolio: Wednesday at noon of Week 13center107315Name: ______________________________________Semester: ___________________________________00Name: ______________________________________Semester: ___________________________________GRADING OF InternshipDAILY LOG & SUMMARYIn detail and not the same thing everydayCriteria MetDate and hours worked /2What I did today/2Something I learned/2What I did well /2What I need to work on/2Summary of your experience —1/2 – 1 page Where you were and what your main job responsibilities were/2Value = 5%/12GROUP PROJECT & MARKETING PLANFACULTY approval due Wednesday at noon of WEEK 3Criteria MetFACULTY approval: if via email you must print email and add to portfolio- ? credit if received after Wednesday noon of WEEK 3/1- Typed, 1.5 spaced, 12 pt font, ? to 1 page summary defining details of your program BEFORE completing it, including target market and what group program you plan to market. - ? credit if received after Wednesday noon of WEEK 3/1Evidence of scholarly activity directly related to the research and implementation of group project (3 scholarly articles with abstracts printed and submitted with your own summary of them)/2SWOT analysis for implementation of your wellness program/class/2Evidence of marketing of plan within the facility and / or community (marketing materials included, power point, brochure, copy of advertisement, pictures etc.)/2Typed, 1.5 spaced, 12 pt font, ? to 1 page summary defining details of your program AFTER completing it, with reflection about when it was completed, who attended, how it went, and what you could have done differently/2Choreography or outline of exactly what you will do with the group/2Supervisor (on-site) signature including date of completion/1Value = 20%/13INDIVIDUAL FITNESS PROGRAMFACULTY approval due Wednesday at noon of WEEK 3COMPLETED program due Wednesday at noon of WEEK 6Criteria MetFSU Faculty approval – if via email you must print email and add to portfolio. - ? credit if received after Wednesday noon of WEEK 3/1Typed, 1.5 spaced, 12 pt font, ? to 1 page summary defining details of your program and your client BEFORE completing it- ? credit if received after Wednesday noon of WEEK 3/1Assessment SectionHealth history form/1Par Q & informed consent /1Medical Clearance FormWaived with signature of client ORSubmitted to physician for signature and date with evidence of completion prior to activity if client had any “yes” answers on PAR-Q/1Body composition analysisMethod used (if skinfold, include numbers for each body part)/2Body mass/weight/2% fat vs % lean mass and actual numbers/2Ideal weightMust be the client’s ideal weight, in line with goals, and healthy and attainable for the client/2Interpretation/assessment (ultra lean, lean, overweight, obese, etc.)/2Musculoskeletal Flexibility Method used (include measurements for each trial)/2Interpretation/assessment (poor, fair, good, excellent, etc.)/2Cardiovascular Fitness Resting HR/2Maximum HR Show work and calculation used /2Target HR (using Karvonen formula at 5 various percentages)Show work and calculation used/2VO2 maxShow work and calculation used/2Blood Pressure (mmHg)Measurement /2Interpretation/assessment/2Musculoskeletal strength for the following (minimum one of each) Describe the tests usedUpper body measurement/2Upper body interpretation/assessment (show work)/2Lower body measurement/2Lower body interpretation/assessment (show work)/2Core strength measurement/2Core strength interpretation/assessment (show work)/2Diet Analysis 3 day initial food journal In detail with portion sizes/5Includes software printout using Dine Healthy, Cengage Learning, Diet Analysis, or other approved software Includes normative values/5Interpretation/assessment of software printoutWhat foods do you recommend? What can your client do to improve his or her diet?/5Design SectionNeeds analysisBiomechanical analysis/5Bioenergetics/2Injury analysis/2Other factors (previous injuries, etc.)/1Goal Assessment Be specific. You will need to discuss accomplishing these in the summary you write. Any weight goals should match ideal weightIncludes short term and long term goals/51-RM Predictions and Actual 1 – RM for ALL strength exercises prescribed /5Periodization Model—with dates, starting ASAP while you are there with the client/15Metabolic Equations / Heart-rate predictions (minimum of 5 predicted HRs) using Karvonen formula (cardiovascular exercise)/5Fitness Program Section Must be in line with clients specific goals and consider under and overtrainingStrength Program: 1 macrocycle (one year) List actual weight for each exercise, not just percentagesWeights need to be less than the client’s max/15Cardiovascular Program: (one year) With appropriate Heart RatesShould line up with bioenergetics assessment /10Flexibility program: (one year)Consider dynamic & static flexibilityDescribe FITT/10Nutrition / weight-loss program: for each cycle of one year programDetailed pre and post workout/10Typed, 1.5 spaced, 12 pt font, ? to 1 page summary defining details of your program AFTER completion, with reflection on how it went and what you could have done differently. (This summary is due with the final portfolio after you have spent the semester training and working with your client.)/2 *Supervisor (on-site) signature including date of completion/2Value =30% (*2 points for summary due with final portfolio at end of semester)/147 *TESTING PORTFOLIOCriteria MetCharts must be numbered with every chart and every page to include a heading/1Include testing protocols and/2Include normative values for assessments/2Body Composition Tests: 100Include your assessment in addition to the % and poundsSkin-fold: at least 50/10Assess any combination of the following tests: Infrared (futrex), BIA, Hydrostatic weighing, Bod-Pod./10Musculoskeletal flexibility: 50 totalWrite all 3 scores and indicate the median with each testInclude assessment of each test/10Sit & ReachApley’s Scratch TestGoniometryStrength Tests:Predicted 1-RM: 25Choose 1 formula to calculate predicted maxMust show your work for credit /15Actual 1-RM: 25/15Blood Pressure: 100Include assessment and recommendations for the client/10Cardiovascular Tests: 30 (any combination of any of the following tests is acceptable unless previous approval of another test is granted by the internship coordinator). MUST include signed informed consent and PAR-Q for each./15YMCA Cycle TestQueens College Step TestLifecycle Fit Test: (Must be completed w/ exercise B.P.)Value = 20%/90EVALUATION FORMSYou should give your supervisor the evaluations at least a week in advance.You should provide the envelope to your supervisor and have him/her seal and sign the back of the envelopeCriteria MetMid-term: ________% DUE WEEK 6 WEDNESDAY AT NOON/10Final: ________% DUE WITH YOUR PORTFOLIO WEEK 13 AT NOON/10 Value = 5% /20PRIOR TO INTERNSHIPCriteria MetSubmission of application by due date in previous semester (2 pts on time, 0 pts late)/2Attend internship meeting previous semester (2 pts attended, 0 pts did not attend)/2Copy of 1st Aid & CPR card in portfolio/1Value = 5% /5DURING INTERNSHIPCriteria MetWeekly online discussions with classmates/13Weekly online/email check-in with your assigned faculty instructor/13Value = 5% /26AFTER INTERNSHIPREFLECTION PAPER/SUMMARY OF INTERNSHIP - Did you accomplish your goals?/1 - What were your personal strengths & weaknesses?/1 - Did your academic coursework prepare you professionally for the internship?/1 - What improvements would you suggest in the academic coursework to prepare you better?/1Final resume—updated with internship experience /1Contact information for after graduation /1Completed EXSS exit exam/1Proof of purchase of ACSM Guidelines book/receipt/1Proof of Professional Membership (NSCA, ACSM, etc)/1Proof of REGISTRATION for a professional certification exam (CSCS, Exercise Physiologist, etc)/1(Note: although it is not graded, students should complete the graduate survey after they finish their internship.)Value = 10% /1090%-100% = A, 80%-89% = B, 70%-79% = C, 60%-69% = D, ≤ 59% = FDecimals will only be carried to 10ths. Rounding up will occur with any 100th value of 5 or higher.4572069850Final Grade: ___________________ / _______________________________%00Final Grade: ___________________ / _______________________________%INTERNSHIP & SEMINAR EXSS 495/492Time-LineApplication Due Date:Spring internship: due October 31Summer internship: due March 31Fall internship: due March 31Winter internship: not applicableList of three potential internship sites: Due with application.Interviews w/ 2 potential internship sites: Must be completed prior to application due date. Evidence of these two interviews must be presented with the application (i.e. letter from internship site, business card w/ supervisor’s signature, etc.). Evidence must be turned in with application.Final Decision regarding the internship site: Due with application.Evidence of professional membership: 1st day of classes-internship semester.Evidence of liability insurance: 1st day of classes-internship semester.Work Schedule with all pertinent contact information: 1st week of classes-internship semester.Faculty Contact: Minimum of once per week, in person, email or on phone.Daily hour log: Must be signed on a daily basis by site supervisor. – Failure to have supervisor sign each day’s log will result in that day’s hours not counting toward the 405-hour requirement.Appendix IDEPARTMENT OF KINESIOLOGY & RECREATIONHEALTH FITNESS INTERNSHIP CONTACT INFORMATIONStudents: 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 November 30th, 2017. Student Name: _________________________________________________________________ GPA: _______________________Phone number: _________________________________________________________ Class standing: __________________ E-mail address: _______________________________________________________________________________________________ When I graduate from FSU, I want to: ____________________________________________________________________________________________________________________________________________________________________________________________________________________________________Previous FE placements: ____________________________________________________________________________________________________________________________________________________________________________________________________________________________________Site Name: __________________________________________________________________________________________________________________Address: ____________________________________________________________________________________________________________________________________________________________________________________________________________________________________Phone Number: ______________________________________________________________ Ext: __________________________Supervisor’s Name: _________________________________________________________________________________________E-mail: __________________________________________________________________________________________________________________Phone Number: __________________________________________________________________________________________________________________Description of the Facility: ________________________________________________________________________________________________________________________________________________________________________________________________________________________________________Your role at that facility as a student: ________________________________________________________________________________________________________________________________________________________________________________________________________________________________________Student Signature: ____________________________________________________________________________________________________________________Supervisor Signature: ____________________________________________________________________________________________________________________Date: ______________________________Name_____________________________________________________ Birth Date________________________Mailing address __________________________________________________________________________________________________________________________________________________________________________________________________Permanent Address __________________________________________________________________________________________________________________________________________________________________________________________________Telephone ____________________________________________Major: __________________________________________________________Expected Graduation Date_________________Grade Point Average (major) ____________ Grade Point Average (overall) _______________Total Semester Hours Completed______________Car: ( ) yes ( ) noWhat professional clubs or organizations are you currently a member of?___________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________What offices have you held and what honors have you received in high school and college?__________________________________________________________________________________________________________________________________________________________________________________________________What job experiences relate to your internship placement?____________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________What would you like to accomplish during your internship? List goals and objectives.____________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________List your strengths and weaknesses as you presently perceive them related to completing an internship.STRENGTHS:_____________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________WEAKNESSES:___________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________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? _______________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________Define professionalism and teamwork. How does this relate to your philosophy of Health/Fitness?_____________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________ List three different topic areas for a special project.____________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________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, the registrar, or on Paws.Questions/ Requirements for potential Internship SitesIs the facility a certified fitness/ wellness center?_________________________________________________________________________________________________________What degree does my potential supervisor have?__________________________________________________________________________________________________________________________________________________________________________________________________________________Does my supervisor/ anyone you will be working with have any specific certifications? (CSCS, NSCA, SCCC, AFPA, etc.) __________________________________________________________________________________________________________________________________________________________________________________________________________________What is your potential supervisor’s favorite part of working at this facility?___________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________What would my daily tasks and duties consist of at this facility?___________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________Who will you work with most closely?_________________________________________________________________________________________________________Are there enough clientele for you to be able to complete my tests needed (minimum of 100)._________________________________________________________________________________________________________Can I complete 405 hours during the semester (30-35 hours/week) at this facility?______________________________________________________________________________Appendix IISTUDENT EVALUATION: MID-TERMInternship EXSS 495Student Intern______________________________ Date_______________________Internship Site Supervisor_____________________Agency_____________________Instructions: Using the criteria listed below, please evaluate the performance of the student during the internship. This form should be returned to the Internship Coordinator:John Wright, Hunter Brakeall, Michele Bennett, or Melody KentrusPersonal QualitiesPoorFairGoodExcellentN/APersonal AppearanceEnthusiasmCooperativenessCourtesyRapport w/ ParticipantsRapport w/ StaffProfessional QualitiesPoorFairGoodExcellentN/ADependabilityDaily PreparationInitiativeReceptiveness to CriticismKnowledgePoorFairGoodExcellentN/AAnatomyBiomechanicsExercise PhysiologyHuman Development and AgingPathophysiology and Risk FactorsHuman Behavior and PsychologyHealth Appraisal and Fitness TestingSafety and Injury PreventionExercise ProgrammingNutrition and Weight ManagementProgram Administration/ManagementElectrocardiographySkillsPoorFairGoodExcellentN/ARisk Factor IdentificationBlood Pressure MeasurementBody Composition MeasurementTreadmill / Bike UseFlexibility TestingStrength TestingElectrocardiogram (ECG) PreparationECG AdministrationECG ReadingExercise PrescriptionExercise LeadershipVerbal Communication to a GroupIndividual CounselingWritten CommunicationOverall PerformanceUnsatisfactory 12345OutstandingPlease list any skills which this student needs to improve and/or include any additional comments here or on the other side of this form.________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________This evaluation has been discussed with the student: ( ) yes; ( ) noRecommendation for employment: ( ) yes; ( ) noInternship Site Supervisor: _______________________________ Date: _____________Appendix IIISTUDENT EVALUATION: FINALInternship EXSS 495Student Intern______________________________ Date_______________________Internship Site Supervisor_____________________Agency_____________________Instructions: Using the criteria listed below, please evaluate the performance of the student during the internship. This form should be returned to the Internship Coordinator:John Wright, Hunter Brakeall, Michele Bennett, or Melody KentrusPersonal QualitiesPoorFairGoodExcellentN/APersonal AppearanceEnthusiasmCooperativenessCourtesyRapport w/ ParticipantsRapport w/ StaffProfessional QualitiesPoorFairGoodExcellentN/ADependabilityDaily PreparationInitiativeReceptiveness to CriticismKnowledgePoorFairGoodExcellentN/AAnatomyBiomechanicsExercise PhysiologyHuman Development and AgingPathophysiology and Risk FactorsHuman Behavior and PsychologyHealth Appraisal and Fitness TestingSafety and Injury PreventionExercise ProgrammingNutrition and Weight ManagementProgram Administration/ManagementElectrocardiographySkillsPoorFairGoodExcellentN/ARisk Factor IdentificationBlood Pressure MeasurementBody Composition MeasurementTreadmill / Bike UseFlexibility TestingStrength TestingElectrocardiogram (ECG) PreparationECG AdministrationECG ReadingExercise PrescriptionExercise LeadershipVerbal Communication to a GroupIndividual CounselingWritten CommunicationOverall PerformanceUnsatisfactory12345Outstanding Please list any skills which this student needs to improve and/or include any additional comments here or on the other side of this form.________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________This evaluation has been discussed with the student: ( ) yes; ( ) noRecommendation for employment: ( ) yes; ( ) noInternship Site Supervisor: _______________________________ Date: _____________Appendix IVSample Daily Journal FormName: _______________________Internship Site: _____________________Date:________________________Daily Hours:_______________________Total Accumulated Hours: ____________What I did today:Something I learned:What I did well:What I need to work on:Supervisor signature: Date:Date:________________________Daily Hours:_______________________Total Accumulated Hours: ____________What I did today:Something I learned:What I did well:What I need to work on:Supervisor signature: Date:Appendix IVFrostburg State UniversityExercise & Sport Science: Health Fitness ConcentrationCooperating Site Internship Agreement & ContractThe 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 EXSS 495 FACULTY as to the scheduled workdays.(5) The intern must contact the EXSS 495 FACULTY several times throughout the internship to report your progress as well as any difficulties that they are experiencing.(6) During the internship experience the 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. Responsibilities of the Sponsoring Internship SiteThe 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, Bod-Pod, 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. CompensationIn 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 be rewarded it is the responsibility of the Intern and the supervising internship facility to determine the appropriate pay scale and schedule.TERMThe 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 InsuranceEach 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.NONDISCRIMINATIONEach 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 erning LawsThis agreement shall be governed by the laws of the State of Maryland, and subject to the exclusive jurisdiction of Maryland State courts.AmendmentsThis 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 SiteName of Sponsoring Site: _________________________________Address: _______________________________________________Authorized Official: (print) ________________________________Authorized Official: (signature) ____________________________Date: _________________________________________________FROSTBURG STATE UNIVERSITYInternship Faculty Supervisor: (print) ____________________________Internship Faculty Supervisor: (signature) __________________________Date: ______________________________________________________ ................
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