COLUMBIA COLLEGE Graduate Program in Organizational Change and Leadership 1301 Columbia College Drive, Columbia, SC 29203

SITE SELECTION FORM FOR INTERNSHIP STUDENTS ONLY

Student is responsible for submitting the completed from including site supervisor’s signature to the Capstone Coordinator two weeks before the term starts. Late submissions will compromise your course grade. Student should submit an updated resume/CV attached to this form. Student should submit brochure(s) and/or literature materials with information about the proposed site. If you have any additional questions please contact the Capstone Instructor. Please print or type. Summer Semester 2014 Date Submitted to Capstone Instructor: _____________ Student Name: ________________________________________________________________________ CC E-mail address: _____________________________________________________________________ Address: _____________________________________________________________________________ Work Phone: _______________ Home Phone: __________________ Mobile: ______________________ Capstone Professor: ____________________________________ Internship Site: Name of Site Supervisor: _____________________________ Title: ______________________________ Telephone: _____________________________________ Fax: ________________________ _________ Email Address: ________________________________________________________________________ Site Address: _________________________________________________________________________ Website: _____________________________________________________________________________ Has the site indicated they will accept you as an internship student? ____________ Date the site indicated they accept becoming your internship site? _____________ On a separate sheet briefly answer the following: 1. What is the mission of the proposed organization? 2. What will your role be in this organization and what activities do you propose to work on? 3. How will this site relate to your career development plan and goals? 4. What skills do you hope to learn or enhance? For program use only: Received _________________ Approved _____________________ By_________________________ Site Selection Form, Revised 4/2012

LOG OF HOURS & PROJECT NOTES Students are responsible for maintaining a Log of Internship Hours and Project Notes. Internship hours are totaled on this form and are due by deadline provided by the instructor. Internship Site Supervisor(s) must sign the log(s) where indicated below. Student is responsible for submitting the completed original log(s) with signatures to the Capstone Instructor. Please print or type. Date submitted to Capstone Instructor: _________________________________________ Student Name: _________________________________________________________________ CC E-mail: Address: _____________________________________________________________ Work Phone: _________________Home Phone: ____________Mobile: ___________________ Capstone Professor: ____________________________________________________________ Internship Site(s): _______________________________________________________________

Total Number of Passive Hours (attendance at presentations, workshops, etc): __________ Total Internship Hours: ____________________

LOG OF INTERNSHIP HOURS & PROJECT NOTES Continued

SITE INFORMATION SHEET

Site Number (Students with multiple internships sites only): _________ Internship Site: ________________________________________________________________ Site Supervisor: ______________________________Title: ______________________________ Telephone: ________________________________ Fax: ________________________________ Email: ________________________________________________________________________ Site Address: ___________________________________________________________________ Website: ______________________________________________________________________ Site Supervisor’s Signature: _______________________________________________________ Date verified and signed by Site Supervisor: _______________

Please note that the information below must be completed each week of the internship. Make copies of the format below as needed. Week # ____________________ Total Hours for Week: ___________________ Date (mm/dd/yy)

Responsibilities & Projects Performed

Time in Service ( >15 min.)

Notes (Include observations, challenges, impressions, or concerns while performing responsibilities)

INTERNSHIP SITE EVALUATION FORM Internship Students Only

Student is responsible for submitting the completed form to the Capstone instructor by deadline provided. Date Submitted to Capstone Instructor: _________________________ Student Name: _________________________________________________________________ CC E-mail: _____________________________________________________________________ Address:_______________________________________________________________________ Work Phone: ______________Home Phone:_______________ Mobile: ___________________ Capstone Professor: ____________________________________________________________ Internship Site: ______________________________________________________________________________ Site Supervisor: _____________________________Title: _______________________________ Telephone: ________________________________ Fax: ________________________________ Email: ________________________________________________________________________ Site Address: ___________________________________________________________________ Website: ______________________________________________________________________ Supervisor’s Signature:__________________ _________________________________________ Internship Site Evaluation Form-Revised4/2012

Part I In order to continually improve the internship experience, please take a moment to answer the following questions as specifically and succinctly as possible. 1.

Briefly describe what you were responsible for accomplishing at the internship site:

2.

Describe the benefits you gained from this internship:

3.

Explain if there is anything about the site or the activities at the site that you think can be improved.

4.

Describe if and how you achieved your learning contract goals.

5.

Describe how your supervisor was available and helpful to you.

6. Please explain whether or not you would recommend this supervisor for future internship placements.

Part II Indicate the number that best corresponds to your thoughts on the following statements. a. This internship experience helped me learn to apply what I have learned in the program. Strongly Disagree 1

Disagree 2

Neither Agree nor Disagree 3

Agree 4

Strongly Agree 5

Strongly Disagree 1

Disagree 2

Neither Agree nor Disagree 3

Agree 4

Strongly Agree 5

b. The internship site supervisor helped me achieve my learning contract goals.

c. This internship site was an adequate organization for achieving my learning goals. Strongly Disagree 1

Disagree 2

Neither Agree nor Disagree 3

Agree 4

Strongly Agree 5

Additional Comments/Suggestions:

Print Student Name: ___________________________________________________________ Student Signature: ______________________________________Date: __________________

LEARNING CONTRACT ALL CAPSTONE STUDENTS

Student is responsible for submitting the completed form, including the site supervisor’s signature to the Capstone Coordinator two weeks before the term starts. Late submissions will compromise your course grade. No internship hours may be accumulated until a signed, approved copy of this form is on file. Please print or type. Indicate: Internship _________________ or Project _____________________ Date submitted to Capstone Coordinator: ____________________ Student Name: ____________________________________ Student ID #: ____________ CC E-mail: _______________________________________________________________ Address: ________________________________________________________________ Work Phone: _________________ Home:________________ Mobile: _______________ Capstone Professor:__________________ Internship Site: ______________________ Site Supervisor: ________________________________ Title: ______________________ Email Address: ___________________________________________________________ Telephone: _________________________ Website: _____________________________ For office use only: Received ________________

Please print or type responses below or attach additional paper.\

1. INTRODUCTION Briefly describe your career and educational goals. This section should be clear and concise, one paragraph in length.

2. CAPSTONE DESCRIPTION Identify and describe your internship site. Describe the function and purposes of the organization/agency and what work you anticipate completing at the site. How does the site assist you in meeting your goals and how will you meet the goals of the organization/agency? Students electing a project will describe their project and how it will assist them in meeting their educational and career goals.

3. CAREER DEVELOPMENT GOALS Career Development goals are those which you have determined to accomplish during the capstone. These goals are linked to your career goals and objectives, and should have been paramount when you began exploring internship site or project. Example: I desire to become more proficient at mediation. Choose three (3) career development goals and list and explain how your site will enable you to attain each goal. These goals should relate primarily to what you want to achieve from your experiential learning experience. 1. Career Development Goal 1:

2. Career Development Goal 2:

3. Career Development Goal 3:

4. INTEGRATED LEARNING How do you plant to integrate substantive, theoretical knowledge into the internship setting or project?

5. LEARNING PROJECTS Describe two (2) specific learning projects you plan to complete during your capstone. These projects should incorporate both your career development goals with goals that are unique to you. For those pursuing the internship option these goals should be developed in collaboration with your site supervisor during your interview. In one paragraph, describe the project and how it will assist you in achieving both goals. Also include a projected timeline for project completion. Example: If your career development goal is to become more adept at mediation, and your site specific learning goal is to observe mediations and eventually comediate, how will this take place? Learning Project 1:

Learning Project 2:

6. LEARNING OUTCOMES/EVALUATION Describe the final result, or demonstrable knowledge, that you plan to turn in for final evaluation. The learning outcomes, or methods of evaluation, should be described in one to two sentences maximum for each Learning Project above. A helpful question to ask yourself (for each) may be: How will I, or my professor, understand that I have achieved my learning project goal? Learning Outcome for Project 1:

Learning Outcome for Project 2:

LEARNING CONTRACT APPROVAL Student Name: _____________________________ Student Signature: __________________________ Date: _____________________________________ Internship Students Only Internship Site Supervisor Name: _____________________ Internship Site Supervisor Signature: __________________ Date:____________________________________________ All Students Capstone Professor Approval: __________________________________

COLUMBIA COLLEGE Graduate Program in Organizational Change and Leadership 1301 Columbia College Drive, Columbia, SC 29203

STUDENT EVALAUTION FORM Date Submitted to the instructor: _________________________________ Student Name: ________________________________________________

Thank you for taking time to evaluate the student who has worked with you this summer. The supervision and evaluation of students in field settings is a vital element in the overall development of each student as they progress through the Organizational Change and Leadership Program. Please send the completed form directly: Cohort 1 : David Alewine 503 Glenwood Ave, AndersonSC 29625 Cohort 2: Linda Salane 1898 Calhoun St, #8 Rainbow Row, Columbia SC 29201 The faculty greatly appreciates your candidness in responding to the following questions and assures you that everything you express in this evaluation is confidential. However, to make use of the information you provide we will create a brief summary of your ranking and comments so that it can be constructively integrated into the student’s learning goals. This evaluation contains four categories of inquiry that include: I. II. III. IV.

Application of substantive organizational change and leadership related knowledge Application of practical organizational change and leadership related skills Professional character and demeanor Collaborative teamwork performance

Please use the following scale to score the student’s performance in these four categories. In order to make the most of the evaluation feel free to make comments and suggestions that can further guide the student in their professional and academic development. Unacceptable 1

Acceptable 2

Exceptional 3

Please print or type:

Site Name: ___________________________________________________________________________ Name of Site Supervisor: _____________________________ Title: ________________________ Telephone: _____________________________________ Email Address: ________________________________________________________________ Site Address: ___________________________________________________________________ I. Application of substantive organizational change and leadership related knowledge Did the student demonstrate and apply expert knowledge in areas such as ethics, negotiation, decision making,, conflict management, group process or make recommendations that apply organizational change and leadership models and theories? Score

Comments

Recommended Changes

II. Application of substantive organizational change and leadership related knowledge Did the student make use of various communication, problem solving, change management and leadership skills? Score

Comments

Recommended Changes

III. Professional character and demeanor How did the student conduct themselves? Score

Comments

Recommended Changes

IV. Collaborative teamwork performance How did the student work with clients, colleagues and you in meeting needs or achieving organizational goals? Score

Comments

Recommended Changes

Please use the space below to provide us additional information that may be helpful to the student or the department in improving the internship/project experience. We are eager to learn of creative and innovative ways to successfully combine academic and supervised practical application opportunities for our students. Additional Comments

Are you and your organization interested in facilitating student supervision in the future? _____ Thank you for your time and consideration in this matter. ______________________________________________________________________________ Site Supervisor Name (Print) Site Supervisor Signature ____________________ Date Summer Semester 2014 For office use only: Received _________________