ࡱ> }z{|- MbjbjDD :&vSh&vShCEDh)h)h)h)h)|)|)|)8)*|)2r,L,(---H.>.$.qqqqqqq$:vx^qh).H.H...qh)h)--Hq333.h)-h)-q3.q33j5p-yt5[X/l8qr02rlPNyF0Nyp5pNyh)5ph..3.....qq1...2r....Ny.........X .(:  Eastern Illinois University INTERNSHIP PLAN School Year: 20__ - 20__ School Psychology Intern:______________________________________________________________________________E#____________________________ Supervising School Psychologist: ___________________________________________________________________________, a school psychology intern, has Been employed full-time by_________________________________________________________________________ School District/Special Education Cooperative. The parties agree that the following learning experiences will be provided during the ___________________________ school year under the direct supervision of ___________________________________________________________________________, a licensed school psychologist (License #: ____________________________). The school administration of School District/Special Education Cooperative understands that the internship is a learning and training experience which stresses the quality and variety of experiences available to the intern. In the training process, there will inevitably be some service to the district. However, it is stressed that the primary purpose of the internship is the training of the intern rather than service to the school district. _____________________________________________________________________________________________________________________________________ School Administrator Date University Intern Supervisor Date New Skill Level (NEW) refers to a skill that is just being learned Developing Skill Level (DEVELOPING) refers to being functionally knowledgeable about delineated process but not yet proficient at an entry practitioner level. Competent Skill Level (COMPETENT) refers to being knowledgeable about and has attained the skill level of an entry level practitioner. The following indicators include minimum required activities to be achieved and evaluated during the internship.  Prescribed ActivitiesFORMATIVE INTERN SELF-RATING Pre-Internship MID YEAR SUPERVISING PSYCHOLOGIST RATING SUMMATIVE SUPERVISING PSYCHOLOGIST RATING Date:Date:Date: New Skill  Developing  Competent  New Skill  Developing Competent No Opportunity New Skill  Developing Competent No OpportunitySTANDARD I Data-Based Decision Making and Accountability (NASP STANDARD II, CAEP GPS 1 and 5, EIU GSLG 2 and 4)1A. Demonstrates knowledge of varied assess- ment and data collection methods including the appropriate technologies.1B. Collects and analyzes data to identify student, program, curriculum, or system strengths and needs using appropriate methods and technologies.1C. Collects and analyzes data to develop effective interventions, services, and programs.1D. Collects and analyzes data to evaluate the progress and outcomes of interventions, services, and programs.1E. Uses appropriate technology to report and document assessment and data collection results in meaningful, appropriate, and professional, formats.1F. Uses nondiscriminatory evaluation procedures. curricula and other instructional materials.1G. Follows legal, regulatory, and ethical parameters in data-based decision making and record keeping.STANDARD II Consultation and Collaboration (NASP STANDARD III, CAEP GPS 4 and 5, EIU GSLG 2 and 3)2A. Uses knowledge and skills in consultation, collaboration and communication to promote effective implementation of services for individuals, groups and systems.2B. Participates in collaborative decision making and problem solving with other professionals to achieve student success.2C Demonstrates skills to consult, collaborate and communicate with others during intervene- tion design, implementation, and evaluation of services and programs2D. Uses technological resources to access, manage, and disseminate information to enhance the consultation process.STANDARD III Interventions and Instructional Support to Develop Academic Skills (NASP STANDARD IV.1, CAEP GPS 3 and 5, EIU GSLG 1)3.1A. Uses assessment and data collection methods to develop appropriate academic goals for children with diverse abilities, disabilities, backgrounds, strengths, and needs based on standards established by the State of Illinois and by local districts.3.1B. Uses assessment results to identify student-learning needs, develop instructional strategies, and contribute to eligibility and IEP planning recommendations.3.1C. Implements services to achieve academic outcomes through instructional consultation to general and special education teachers.3.1D. Uses evidence-based strategies to develop, implement, and evaluate services at the individual, group, and systems levels and to enhance classroom, school, home, and community factors related to childrens cognitive and academic skills.3.1 E. Uses current technology resources when designing, implementing, and evaluating instructional programs or interventions for children to reach academic goals.3.1F. Demonstrates awareness of resources for adaptive/assistive devices/technology for 鶹ý with special needs to reach academic goals.STANDARD IV Interventions and Mental Health Services to Develop Social and Life Skills (NASP STANDARD IV.2, CAEP GPS 3 and 5, EIU GSLG 1 and 3)4.2A. Use assessment and data collection methods to develop appropriate social- emotional, behavioral, and mental health goals for children with diverse abilities, disabilities, backgrounds, strengths, and needs.4.2B. Integrates behavioral supports and mental health services with academic and learning goals for children.4.2 C. Uses evidence-based strategies to promote behavior change through the provision of consultation, behavioral assessment and intervention, and counseling services to enhance classroom, school, home, and community factors related to childrens mental health, socialization, and learning.4.2D. Uses appropriate assessment techniques to monitor and evaluate the performance and progress of 鶹ý and the effectiveness of mental health programs in reaching social-emotional/behavioral goals.4.2E. Facilitates the implementation of strategies to improve instructional environments, and maximizes 鶹ý academic learning time.4.2F. Develops intervention programs to facilitate successful transitions of 鶹ý from one environment to another (e.g., program to program, early childhood to school, school to work).4.2G. Uses current technology resources when designing, implementing, and evaluating Instructional programs or interventions for social-emotional/behavioral goals.4.2H. Demonstrates awareness of resources for adaptive/assistive devices/technology for 鶹ý with special needs to reach social-emotional/behavioral goals.STANDARD V School-Wide Practices to Promote Learning (NASP STANDARD V.1, CAEP GPS 3 and 5, EIU GSLG 1)5.1A. Demonstrates knowledge of school and systems structure, organization, and theory including general and special education.5.1B. Demonstrate knowledge of evidence-based practices that promote academic outcomes, learning, social development, and mental health school-wide.5.1C. Uses technology-based tools to manage school or system-wide functioning including data collection, analysis, reporting, and presenting effectively and efficiently.5.1D. Demonstrates skills in developing and implementing practices and strategies that result in effective and supportive learning environments for children and others.5.1E. Demonstrates understanding of school policies, regulations, services, and accountability systems for effective school-wide services.STANDARD VI Preventive and Responsive Services (NASP STANDARD V.2, CAEP GPS 3 and 5, EIU GSLG 1)6.2A. Demonstrates knowledge of principles and research related to protective and risk factors in learning and mental health.6.2B. Demonstrate skills in multi-tiered early intervention and prevention support systems.6.2C. Demonstrates skills in evidence-based crisis response strategies.6.2D. Collaborates to promote services that enhance learning, mental health, safety, and physical well-being.6.2E. Promotes protective and adaptive factors to promote well-being in collaboration with other service providers.6.2F. Demonstrates knowledge of effective crisis preparation, response and recovery.STANDARD VIIDirect and Indirect Services-Family-School Collaboration (NASP STANDARD VI, CAEP GPS 4 and 5, EIU GSLG 2 and 3)7A. Identifies diverse cultural issues, situations, contexts, and other factors that have an impact on familyschool interactions and addresses these factors when developing and providing services for families7B. Designs, implements, monitors, and evalu- ates programs that assist parents with promoting positive academic/social-behavioral outcomes for their children and parental issues and concerns.7C. Designs and implements evidence-based practices and policies that facilitate family school partnerships and interactions with community agencies to enhance academic, learning, social, and mental health outcomes for all children.7D. Maintains useful and accurate records and communicates information responsibly to families/guardians, 鶹ý, colleagues, and community as appropriate. 7E. Utilizes technology appropriate for identifying potential programs, monitoring, and evaluating outcomes related to effective family-school collaboration.STANDARD VIII Diversity in Development and Learning (NASP STANDARD VII, CAEP GPS 4, EIU GSLG 2 and 3)8A. Recognizes the subtle racial, class, gender, cultural, and other biases and the ways in which these biases influence decision making, instruction, behavior, and long-term outcomes for 鶹ý by demonstrating sensitivity and respect for cultural diversity and using skills needed to work with families, 鶹ý, and staff with diverse characteristics.8B. Promotes practices that help 鶹ý and families of all backgrounds feel welcome and appreciated and individual differences including but not limited to gender equality and non-sex role stereotyping are respected in the school and community by acknowledging, supporting, and integrating the activities and talents of all 鶹ý into instructional programs, learning communities, and other settings.8C. Develops strategies to promote an understanding of the role of cultural barriers on educational outcomes and uses strategies to mediate cross-cultural conflicts and to teach interpersonal skills.8D. Recognizes that experiential and linguistic differences can result in learning difficulties and apparent disabilities for 鶹ý.8E. Incorporates information about 鶹ý, families, cultures, communities, primary and secondary language learning and the effects of second language learning when designing assessments and evaluations of progress and designs assessments and intervention strategies appropriate to each students gender, culture, stage of development, learning style, exceptionality, strengths and needs.8F. Develops academic and social/behavioral interventions that reflect knowledge and understanding of 鶹ý and families culture, background, second language learning and individual learning characteristics.8G. Identifies when and how to access and/or make referrals for additional services or community resources to assist 鶹ý with diverse learning needs.8H. Participates in professional continuing education to minimize biases and to enhance training and expertise.STANDARD IX Research and Program Evaluation (NASP STANDARD VIII.1, CAEP GPS 1 and 2, EIU GSLG 4)9.1A Demonstrates knowledge of research design, statistics, measurement, data collection and analysis techniques.9.1B Demonstrates skills to apply research in service delivery9.1C. Uses various techniques and technology resources for data collection, measurement, analysis and program evaluation to support effective practices at the individual, group, and systems levels.9.1D. Uses technology (e.g., Digital media internet, e-mail, interactive video, distance learning) to acquire and or disseminate information and current research findings.9.1E. Uses technology in collaborating and conducting research.STANDARD X Legal, Ethical, and Professional Practice (NASP STANDARD VIII.2, CAEP GPS 6, EIU GSLG 5)10.2A. Provides school psychological services (assessment, consultation, intervention and general professional practice) consistent with prevailing legal, ethical (APA and NASP), and professional standards (e.g., NASP Guidelines for the Provision of Sch. Psych. Services) and participates in legal requirements for professional develop.10.2B Understands how the practice of school psychology affects 鶹ý and families from diverse backgrounds.10.2C Maintains useful and accurate records and communicates information responsibly to families/guardians, 鶹ý, colleagues, and community members as appropriate to provide effective services to 鶹ý.10.2D Practices ethical, legal, and socially responsible behavior when using technology and computer software.10.2E Adheres to copyright laws and guidelines in the access and use of information from various technologies.STANDARD XI Interns Work Characteristics/Disposition, PROGRAM (CAEP GPS 6, EIU GSLG 5)Shows Dependability and Initiative Timeliness  Quality of work Follow through Assumes leadershipShows Respect for Human Diversity Avoids group or class attributions Works well with diverse groupsShows Ethical responsibility Uses evidence-based practices Adheres to ethical practices (e.g., NASP) Shows Adaptability Resourceful Adapts to the demands of a situation Shows good Communication Skills Writing skills (fluent and free of errors) Shows good Oral communication skills (understandable) Presentation in a group setting Listens, reframes, clarifies Sensitive to nonverbal cues Elicits FeedbackShows good Interpersonal skills Receptive to feedback Works well with others Appropriate interactions with 鶹ý, parents, and school personnel  Shows respect to differences of opinions __ ___________________________________________________________________ has successfully completed the above Internship Plan and is recommended for Intern Name licensure as a school psychologist. The intern has completed a minimum of 1200 hours of service in a full-time capacity over one full academic year. There were two component to the internship experience: The primary internship site was at a  FORMCHECKBOX  high school or  FORMCHECKBOX  elementary/preschool level and was provided at ________________________________________________________________________________________________________________________________________. Name of School and Location In order to afford a well-rounded internship experience the candidate also spent a minimum of 20 days at a  FORMCHECKBOX  high school or  FORMCHECKBOX elementary/preschool level. This component of the internship was completed at_______________________________________________________________________________________. Name of School and Location The intern had an opportunity to visit program/school _________________________________________________________________________________________, Name and Location not directly involved in the internship. In addition, the intern was involved in the following non-school community agency(s):_____________________________ ________________________________________________________________________________________________________________________________________. ______________________________________________________________________ _________________________________________________________________. Signature, Cooperating Intern Supervisor Date Notes: Original signature pages (first and last pages) must be submitted to the School Psychology Program, Eastern Illinois University. 2. The supervisor is welcome to add pages for comments, if necessary.      PAGE 2 of  NUMPAGES 12 ./?HIJK\]   5 ? 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