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LYNCHBURG REGIONAL GOVERNOR'S

STEM ACADEMY

XLRS STEM Academy

Senior Internship Experience

Student: -------------

Mentor: -------------

Internship Location: _________ _

Internship Time(s): __________ _

LYNCHBURG REGIONAL GOVERNOR'S

STEM ACADEMY

August 18th, 2020

• Co-Op/Internship Education Application

• Cooperative/Internship Education Student

Agreement

Centra Interns ONLY

• Demographics Form

• Parent Permission Form

• Media Release Form

• Student Behavior/Rules Form

• Confidentiality Form

• FERPA Form

• Affiliating Health Record

September 11th, 2020

• Draft Resume due by 5pm

October 16th, 2020

• Final Resume due by 5pm

November 6th, 2020

Centra Interns ONLY

• Proof of Negative TB test

• Proof of Flu Shot

• Immunization Record

Internship Due Dates

Checklist

November 24th, 2020

• Spring Class Schedule form completed

• Two (2) Instructor Recommendations

December 11th, 2020

• Learning Agreement -Signed- during

mentor meeting (Day and Time TBD)

January 6th, 2021

• First Day of Internship

April 28th, 2021

• Presentations

May 3rd, 2021

• Internship Log Sheet-signed by mentor

• Written Reflection Paper due by 5pm

• Mentor Evaluation-Mentor will submit

• On-site Evaluation- Mr. Fisher will

submit