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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