Guidelines to Complete Internship Contract Please complete the following steps before starting an internship: 1. Secure an internship site.

If you need assistance locating an internship schedule a meeting with the Office of Experiential Programs or email CareerServices@HarrisburgU.edu well in advance of the semester in which you register for an academic internship. Students should begin searching for an internship at least one semester prior to registration. The Office of Experiential Programs will be able to provide guidance with application materials and interview preparation. 2. Obtain Instructional Technology Specialist internship description or project ideas from internship site supervisor. You will need this information to effectively develop the learning contract with your internship advisor. 3. Complete Internship Application portion of Internship Contract. 4. Schedule meeting with your internship advisor. Develop your learning agenda and project plan with your internship advisor. Meeting with Internship Advisor: Time: _______________________________

Date:_________________________

5. Provide Internship Application, Learning Agenda, Project Plan, Internship Site Agreement and Addendum for Unpaid Internships (if applicable) to Internship Site Supervisor to review and sign. 6. Submit signed Internship Application, Learning Agenda, Project Plan, Internship Site and Addendum for Unpaid Internships (if applicable) to Office of Experiential Programs who is responsible for processing. One copy will be kept with the Manager of Experiential Programs and one copy emailed to the student, faculty supervisor, internship advisor and Office of Records & Registration. *Student is responsible for obtaining all required signatures listed on internship documents. It is important that any individual who signs on behalf of your internship has contracting authority to legally execute the enclosed agreements.

INTERNSHIP APPLICATION INSTRUCTIONAL TECHNOLOGY SPECIALIST

Course Number: LTMS 698 Learning Technologies Internship Instructional Technology Specialist Prerequisites: Prerequisites to completing an internship include; GRAD 695 and permission of advisor. Course Description: The student conducts learning technology-related activities at an organization to apply concepts and skills previously explored throughout the program. This experiential course also provides an opportunity to demonstrate and further develop the eight University competencies, i.e. critical thinking, communication, teamwork and collaboration, entrepreneurship, information literacy, ethical decision making, global awareness and civic engagement. Offered as needed. Course Goals and Learning Objectives: The Information Technology Specialist Certification requires candidates to demonstrate an understanding of the fundamental and advanced concepts of instructional technology planning and applications at elementary, middle and secondary levels (K-12). As a part of the internship contract, all students will establish learning goals and objectives for the internship. Learning goals and objectives will be established with a student, faculty supervisor and site supervisor in accordance with requirements for the Instructional Technology Specialist Certification. The learning goals and objectives must be approved by the faculty supervisor, site supervisor and Office of Experiential Programs prior to beginning an internship. Harrisburg University Competencies: Internship sites can satisfy all eight Harrisburg University competencies depending on the type of placement. Students should be thinking of this throughout the internship as some competencies may be more recognizable than others. Students should provide artifacts which address the competencies utilized during the internship. Students should include this information in the eportfolio. Project Plan: A completed project plan is required with a faculty supervisor setting out a schedule of meetings (minimum of three per semester), due dates for any work submissions and other matters the faculty supervisor deems important. A student should be submitting progress updates to the faculty supervisor at least five times throughout the semester. Student attendance at scheduled meetings with faculty supervisor will be factored into a students grade. The failure to attend scheduled meetings or submit required documents will negatively impact a students grade. Evaluations: A student will have the opportunity to evaluate their internship experience at the midterm of the semester and at the end of the semester via an online evaluation form distributed through the Office of Experiential Programs. A site visitation at the midterm of the semester will be conducted with a students site supervisor and the Office of Experiential Programs. A students site supervisor will evaluate the students performance at the midterm and end of the semester via an online form distributed through the Office of Experiential Programs. Evaluations will be returned to the student to be include in the final portfolio. Grading Policies: The faculty supervisor will assign a grade based on the submission of the following on or before the final day of the semester: Student ePortfolio Timesheets indicating minimum of 135 hours completed Weekly journal/reflective writings

Evaluations and Site Visitation from Site Supervisor Evaluations from Student Faculty will also take into consideration a students attendance at the internship site, attendance at scheduled progress meetings with faculty, communication throughout the internship with site, faculty supervisor and Office of Experiential Programs, attitude and ability to complete assignments within deadlines. Confidentiality: Students must be cognizant of the requirements of confidentiality within the workplace. This means that students agree not to divulge information regarding the workplace outside of the internship. Be very careful about what is discussed outside of the internship site. At the conclusion of the semester, students are required to submit a comprehensive eportfolio including the following: Original internship contract Resume Internship description/job description Weekly journals 2 page reflective paper focusing on 4 of the Harrisburg University competencies selected on internship contract Timesheets approved by site supervisor representing a minimum of 135 hours Midterm Evaluation from site supervisor and student End of Semester Evaluation from site supervisor and student Artifacts of knowledge, performance and professionalism related to the Instructional Technology Specialists certificate Personal growth plan Other items that can be included as applicable: Meeting reports Presentation Photos Research documents Projects Any other documents that are non confidential in nature

The eportfolio will be submitted to the students faculty supervisor and to the Office of Experiential Programs. The students eportfolio is due on or before the final day of the semester in which the student is registered, unless otherwise noted in the Office of Experiential Programs. Signing this form affirms you have read and understand the requirements for completing an academic internship at Harrisburg University. __________________________________________ Student Signature _______________________ Date

To be completed by Registrar: Student Name: _________________________ Course Name & Number: _________________ Total amount of academic credit student will receive for project: ___________________ Semester academic credit will be received: FA SP SU Year: _________

Instructional Technology Specialist Internship Application

Students are required to submit the completed application to the Office of Experiential Programs on or before the deadline indicated on the academic calendar for the semester in which they are registered for the course. Students will not receive academic credit for the internship if completed contract is not submitted by the deadline. A copy of this form will be sent to the student, internship advisor and internship site supervisor.
I am pursuing the Instructional Technology Specialist certification from the Pennsylvania Department of Education

To be completed by Student:
Term/Semester: Fall Course Number: LTMS 698 Faculty Internship Advisor: Andy Petroski Expected Start Date: 9/11/2012 Number of Hours Student Expected to Work: 135 Internship is: Paid Voluntary/Unpaid Year: 2012 Declared Major: LTMS Faculty Advisor: Andy Petroski Expected End Date: 12/2012 Hours Per Week: 8

STUDENT CONTACT INFORMATION: Student Name: Arthur Titzel Student Address: 5 Scarsdale Drive City: Camp Hill Home Phone: 717-730-9809 Email (HU): atitzel@harrisburgu.edu Number of Academic Credits Earned: 36 GPA: 3.90

State: PA

Zip: 17011 Cell Phone: 717-557-6675 Email (personal): atitzel@gmail.com

ORGANIZATION CONTACT INFORMATION: Organization Name: Derry Township School District Organization Address:PO Box 898, 30 East Granada Ave. Internship Supervisor: Al Harding Supervisor Phone: Student Interns Position: City: Hershey State: PA Zip: 17033

Supervisor Title: Director of Technology Supervisor Email: aharding@hershey.k12.pa.us

To be completed by the student after consultation with the Faculty Internship Advisor and Site Supervisor. Please type.

Instructional Technology Specialist - Internship Site Agreement and Learning Agenda

Internship Description: I. How did you learn about the internship? I learned about the internship through being a student in the LTMS program. II. What is the general nature, function, or business of the organization in which you propose to serve your internship? K12 public school district

III.

Position Description: What will your role be as an intern in that organization? What specific duties do you expect to perform, participate in, or observe under the direction of your Site Supervisor? (Attach job description) See attached Job Description

IV.

What Harrisburg University Competencies does this internship address? Why? See HU Competency/Internship Experience Alignment attachment

Learning Objectives: I. Explain briefly why you want to do this particular internship. What do you hope to learn? How is this internship pertinent to your present academic and personal interests and your future educational, career, and/or personal goals? The internship experience is required as part of the LTMS ITS graduate requirements. On a professional level the experience will be a valuable experience as I intend to gain working knowledge of how a school districts technology department operates. I hope to gain experience providing professional development training to classroom teachers on an as needed and a more formally structured environment. In addition, I anticipate gaining valuable knowledge in computer maintenance, help desk, technology infrastructure, and district-wide technology planning. It is my goal to use the internship experience and resulting LTMS degree and ITS certification to be a leader in technology integration in K-12, whether informally in my daily practice, or formally through being a technology integrator, consultant, or other related position. Learning objectives for Instructional Technology Specialist internships must demonstrate their knowledge of and competence in the following: 1. Managing instructional technology services including creating an environment that fosters interest and growth in all aspects of technology, establishing and maintaining rapport with all staff and students, communicating high learning expectations, and creating a safe physical environment that is conducive to learning 2. Planning, preparation and delivery of technology related in-service programs and instruction in collaboration with other professionals at a variety of instructional levels that utilize technology in

problem solving based upon Pennsylvania Academic Standards, strengths and needs of learners at all levels of technological proficiency and established technology implementation plans. 3. Selecting, implementing and adapting technology to teaching methodologies, curriculum resources and administration functions in collaboration with other educators and integrating a variety of software, applications and learning tools. 4. Selecting, developing and administering assessments that utilize technological applications and involve multiple indicators of student progress and using technology to maintain records on student achievement. 5. Developing leadership techniques for working with all levels of the educational community and to manage and administer instructional technology programs at the building and district levels including developing plans to assess the technological needs and resources, and to evaluate technology implementation and outcomes, developing plans to configure computer/technology systems and related peripherals in laboratory, classroom clusters, and other instructional and administrative arrangements and developing systems for the secure maintenance of student records 6. Collaborating with school colleagues to enhance student, teacher and administrative capabilities and improve student learning 7. Communicating effectively with parents/guardians, other agencies and the community at large to support learning by all students 1. Student will demonstrate the ability to effectively plan and deliver technology based workshops to classroom

teachers that are organized and communicated in a clear manner.

th 2. Student will plan and implement an online work order tracking form to be used by 8 grade students to repair

their school issued student laptop.

3. Student will design and implement a needs assessment for special education teachers to identify student

learning needs.
4. Student will collaborate with special education teachers to identify and catalogue mobile apps to address special education student needs as identified in a needs assessment. 5. Student will design and implement a needs assessment to identify teacher knowledge gaps related to core

technology tools. 6. Student will create online tutorials addressing teacher knowledge gaps related to core technology tools.
Supervision: I. Describe in detail the supervision to be provided. Include what kind of instruction and assistance you will receive from the Site Supervisor. Who will you speak to if a problem arises? There will be regular biweekly meeting between Al Harding (Site Supervisor) and myself to discuss my progress, plans and goals. The site supervisor will teach about multiple facets of the District-wide technology plan, including managing the instructional technology services, planning and delivering in-services, developing leadership techniques, and collaboration/communication strategies for ensuring successful implementation of technology plan. If a problem arises the contact person will be the site supervisor. In addition to the site supervisor, I will be working closely with Tom Spangler (Computer Technician), and Traci Landry and Mark Painter (Technology Integrators) on a more frequent level. I will work with the Computer Technician to gain help desk and computer maintenance/repair experience; and, with the Technology Integrators to gain professional development planning and delivery experience.

Evaluation: I. How will your work performance be evaluated and by whom? The Site Supervisor will evaluate my performance based on observation of duties, bi-weekly meetings, time sheets, weekly journal, and feedback from the Computer Technician and Technology Integrators.

Internship Project Plan:

List of Scheduled Meeting Dates with Faculty Internship Advisor: 1. Tuesday, September 11, 2012 2. Tuesday, October 2, 2012 3. Tuesday, October 23, 2012 4. Tuesday, November 13, 2012 5. Teusday, December 4, 2012 Documents to be submitted to Faculty Internship Advisor and Due Dates: Document Title: Due Date: 1. Time sheets Bi-Weekly 2. Journal Weekly 3. Project Overview Friday, September 21, 2012 4. Mid-Term Evaluation Wednesday, October, 2012 5. Project ePortfolio Saturday, December 15, 2012 NOTE TO THE STUDENT: Regular meetings with you Faculty Internship Advisor in connection with the academic component throughout the internship are expected. Regular communications with the Office of Experiential Programs throughout the internship are expected. It is the STUDENTS responsibility to ensure that a schedule for regular meetings listed below is adhered to. Signing this form affirms that the learning objectives, activities, and hours listed above are acceptable to the sponsoring organization and meeting the students educational goals. Signing this form indicates you agree to complete the number of hours state above that meets the needs of the internship organization AND is relevant to this course.

__________________________________________________ Student Signature __________________________________________________ Internship Site Supervisor __________________________________________________ Faculty Internship Supervisor __________________________________________________

_________________________ Date _________________________ Date _________________________ Date _________________________

Office of Experiential Programs

Date

Internship Site Agreement

This agreement establishes the relationship between Harrisburg University of Science and Technology (referred to as the "University"), an educational institution in the Commonwealth of Pennsylvania and Derry Township School District (referred to as the "Organization"). The University offers degree programs in a variety of disciplines, which are academically enhanced by practical experiences outside of the traditional classroom setting. For this agreement the Organization shall provide practical experience pursuant to the terms of this agreement and serve as an internship site offering facilities, resources, and supervision to students. Both parties agree to the following: I. Duties and responsibilities of the University

The University will be responsible for internships that are conducted during a regular academic semester(s) or scheduled

summer term(s). The University and the Organization agree to schedule the internship hours to mutually benefit all parties involved and to conform to the scheduling formula of 45 hours of site contact to equal one credit. a. If the internship begins at a point later than the add/drop date of a regular academic semester (Semester A), then the University will award internship credit the following term (Semester B) as long as the following conditions are met: i. internship paperwork is completed and submitted to the Office of Records and Registration before the student begins the internship; ii. the student registers for the internship by the add/drop date of Semester B; and iii. at minimum, half of the total internship hours are performed during Semester B. For a three-credit internship, 70 hours or more shall be performed in Semester B. 2 The University shall certify eligibility for students registering internships for academic credit. Approved students will have the appropriate educational background and skills consistent with the advertised internship and departmental requirements for participation. 3 The University determines the amount of academic credit to be earned through the internship and establishes all academic requirements that the student must meet to earn the credit. The University establishes a grading system and criteria to earn the grade upon completion of the internship. 4 5 The University will assign a faculty member to monitor and evaluate the student's performance during the internship. The The University, at the beginning of the internship term, will provide the Organization with all evaluation materials and the University will assume all costs associated with the faculty supervision of the intern.

expected timeline for submission. 6 7 8 The University agrees to advise the students of any known policies, procedures, and requirements of the internship as The University, at the beginning of the internship term, will inform the Organization of course requirements such as the The University may require termination of the internship placement for any student not complying with University specified by the Organization. intern's attendance at meetings/seminars or activities that may take the intern away from the assignment. guidelines and procedures for the internship program, as long as the Organization has been notified in advance. II. Duties and responsibilities of the Organization

The Organization agrees to prepare an internship job description that outlines the duties and responsibilities of the intern.

The University will use this document to determine the suitability of the internship for academic credit. Should a change to the job description be necessary after the internship is approved, the Organization agrees to notify the University of any change. 2 3 4 The Organization agrees to notify the University of any selection criteria and requirements of the selection process The Organization selects interns based on the Organization's needs and preferences. The Organization determines the schedule that the intern will maintain on the premises. The total scheduled hours will including, but not limited to, background investigations, drug testing, health screening, etc.

comply with standards established by the University for awarding credit hours: 45 hours of site contact equals one semester credit hour. a. If the internship begins at a point later than the add/drop date of a regular academic semester (Semester A), then the Organization agrees to allow the intern to work a minimum of half of the internship hours during the subsequent semester (Semester B). For a three-credit internship, 70 hours or more shall be performed in Semester B. 5 The Organization, at the beginning of the internship, determines the amount of compensation, if any, received by the intern. The Organization will inform the University if interns will receive an hourly wage, stipend, or will serve in a non-paid capacity. 6 7 The Organization agrees to provide suitable workspace and resources for the intern to complete the internship assignment. The Organization shall provide all reasonable information requested by the University on a student's internship The Organization will also provide orientation, training, supervision, and evaluation of the intern. performance. If there are any student evaluations, they will be completed and returned according to any reasonable schedule agreed to by the University and the Organization. 8 The Organization agrees to make every possible accommodation to the University's request for a faculty or designee site visit during the internship. The Organization also agrees to allow the intern to attend University-required internship meetings/seminars during the internship. 9 Should the Organization become dissatisfied with the performance of a student, the Organization may request removal of the student. This should only occur after the University has been notified in advance and a satisfactory resolution cannot be obtained.

10

Ill. Mutual terms and conditions

The effective term of this agreement shall be Septebmer 11, 2012 through

. The University or the

Organization may terminate this agreement with 10 days notice. Should the Organization wish to terminate the agreement prior to completion of a semester/term, any student intern(s) will have the opportunity to complete their internship. In the event of a substantial breech, either party may terminate this agreement. 2 The parties agree to continue their respective policies of nondiscrimination based on Title IX of the Civil Rights Act of 1964 in regard to sex, age, race, color, creed, national origin, Title IX of the Education Amendments of 1972 and other applicable laws, as well as the provisions of the Americans with Disabilities Act. 3 4 The laws of the Commonwealth of Pennsylvania shall govern this Agreement. The relationship between the parties in this Agreement to each other is that of independent contractors. The relationship

of the parties to this contract to each other shall not be construed to constitute a partnership, joint venture, or any other relationship, other than that of independent contractors. 5 This Agreement represents the entire understanding between the parties. This Agreement shall only be modified in writing with the same formality as the original Agreement. The authorized representatives of the parties have executed this Agreement as of the date indicated below.

__________________________________ University

________________________________ Organization

__________________________________ University Authorized Signature

________________________________ Organization Authorized Signature

_________________________________ Print Name/Title Effective Date of Agreement (date of last signature): ____________________________

__________________________________ Print Name/Title

Please sign and return to: Office of Experiential Programs, Harrisburg University of Science and Technology, 326 Market Street Harrisburg PA 17101

11

Code of Professional and Ethical Conduct for Student Interns

General Statements: While interning are you site, you are representing not just yourself, but Harrisburg University of Science and Technology and your fellow students, both current and future. Whether you do well or not at your site may have implications far beyond your current situation. You are governed by the employers employment policies, practices, procedures, dress code and/or standards of conduct. To avoid any misunderstanding, it is recommended that you obtain clarification regarding such matters from your employer when you begin your assignment. Your performance while on assignment as an intern may be measured by your employers performance measurement process and Harrisburg Universitys internship evaluation process. You must receive a satisfactory (or better) performance rating for the period of your internship for the internship to be recognized by the University. You must keep both the University Internship Office and your sponsoring employer apprised, at all times, of your current email address, physical address and telephone number. You understand that permissible work absences include illness or other serious circumstances. Keeping pace with coursework or co-curricular activities are not legitimate excusals. You will be responsible to notify the employer and the Manager of Experiential Programs immediately in case of absense. Any changes in your internship status (layoff, cutback hours, or dismissal) must be reported immediately to the Manager of Experiential Programs and your faculty advisor. Due to the nature of an internship arrangment, you may not withdraw from a site except in severe and justifiable circumstances as determined by the Manager of Experiential Programs in consultation with the cooperating site sponsor. A dishonorable dismissal will nullify the internship arrnagement at the risk of academic penalty and loss of tuition. You will follow all policies and procedures of the internship, as well as the University policies for on-campus classes. This includes completion of all assignments related to the internship. Specific Statements: You will conduct yourself in a professional manner at all times. This includes, but is not limited to: Maintaining confidentiality regarding information accessed on any patients, clients, members, customers, employees and products or services associated with the internship site; Reporting for the internship on time; Using appropriate written and oral expression in all interactions with University personnel, managers, supervisors, employees, the public and clients; Participating in any orientation or testing required by the internship site.

12

Observing all established safety and sanitation codes; Engaging in positive, good, legal behavior; Accepting responsibility and accountability for decisions and actions taken while at the internship site; Ensuring that all interactions with guests, patients, clients, members, customers, the public and fellow employees are conducted with dignity and respect towards every person.

By my signature below, I indicate my understanding of, and willingness to confirm to, the professional standards of the internship program delineated in the preceding general and specific statements. If any facet of the code of doncust is not adhered to, I may be at risk of losing academic credit/tuition, or in some other way may be penalized. Name (print):_________________________________________________________________________ Signature: ______________________________________________ Date: _______________________

Harrisburg University | Code of Professional and Ethical Conduct for Student Interns Adapted from Internship-Net Template 12.12.07

13

Internship Agreement Addendum for Unpaid Internships

I understand and agree that, according to the federal regulations, an internship can legally be offered as unpaid if the following conditions apply: 1. The training, even though it includes actual operation of the facilities of the employer, is similar to what would be given in a vocational school or academic educational instruction; 2. The training is for the benefit of the trainees; 3. The trainees do not displace regular employees, but work under their close observation; 4. The employer that provides the training derives no immediate advantage from the activities of the trainees, and on occasion the employers operations may actually be impeded; 5. The trainees are not necessarily entitled to a job at the conclusion of the training period; and 6. The employer and the trainees understand that the trainees are not entitled to wages for the time spent in the training. If all of the factors listed above are met, then the worker is a trainee, an employment relationship does not exist under the FLSA, and the FLSAs minimum wage and overtime provisions do not apply to the worker. ________________________________ Organization Name ________________________________ Date ________________________________ Signature ________________________________ Printed Authorized Official ________________________________ Title ____________________________ Please sign and return to: Office of Experiential Programs Harrisburg University of Science and Technology 326 Market Street Harrisburg PA 17101

14