Academic Path Applicants Only-Academic Internship Verification Form
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2ACADEMIC PATH APPLICANTS ONLY-Academic Internship Verification Form
CTRS Academic Internship Supervisor
Verification of Internship Experience in Therapeutic Recreation/Recreation Therapy: The individual listed
below has indicated the completion of the internship in therapeutic recreation/recreation therapy. To the best of your
knowledge and according to your records, please answer the following questions regarding your supervision of the
applicant listed above:
Full Name of NCTRC Applicant
Agency Name
First month/day/year of placement
Final month/day/year of placement
Average number of hours per week during internship
Total weeks of internship
Total hours completed during internship
1.
Were you the applicant’s academic internship supervisor?
2.
Did you provide academic supervision to the applicant during
the internship experience?
3.
Were you employed by a college or university throughout the applicants entire
internship experience?
4.
Did the applicant complete the internship experience corresponding to the
dates, number of weeks and total hours indicated above?
5.
Was this placement for a minimum of 14 consecutive weeks and at
least 20 hours per week?
6.
Was the applicant you supervised exposed to opportunities to develop
skills related to the therapeutic recreation/recreation therapy process as
defined by the current NCTRC National Job Analysis Task Areas listed
below?
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