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Kihei Charter School - Tracking Form

High School Internship program - 2017-2018

Student Name: __________________________ Class period 2 / 4 / 5

Proposed possible site(s):
Name or Type of Site Mentor name/position Contact / Date Notes
1- _____________________ __________________ _________ _____________
2- _____________________ __________________ _________ _____________
3- _____________________ __________________ _________ _____________

Date Submitted Date Approved
(student) (director)
Overview
1. Internship Requirements _________ __________
2. Letter to parent or guardian _________ __________

Finding and approving the best internship
3. Approval Form _________ __________
4. Setup Form _________ __________
5. Mentor Background Check Form _________ __________
6. The approval process (in-class) _________ __________
7. Approved Internships List _________ __________

Completing internship requirements and paperwork
8. Blog Guidelines _________ __________

9. Time log _________ __________
10. Mentor/Student Evaluation _________ __________
11. Final Evaluation _________ __________
12. Final survey (online) _________ __________

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Summer Internship Requirements
Internships are a requirement to graduate from Kihei Charter School (KCS) students.
Student are required to complete their internship during the summer between their
junior and senior year. Below are the guidelines. March 3, 2017

Approval
Prior to starting, all summer internships must be approved by your internship
coordinator/junior seminar teacher. Internships must be approved in advance of
work beginning.

Setup
It is the student's responsibility to set-up the internship paperwork fully during the
Junior Seminar class by the end of the Spring quarter

Documentation
The following documentation must be completed:

● Approval Form
The approval form is a quick outline of your summer internship plans.

● Parent Permission Form
This form confirms that you and your parents know that you are completing a
summer internship and understand the requirements in order to receive
academic credit. This form must be filled out and handed in prior to starting
your internship and before the last day of school.

● Setup Form
The setup form outlines the details of your internship (who, what, when, why
and where). This form must be filled out COMPLETELY including all mentor
and internship contact information.

● Background check
It is KCS policy that all mentors complete a background check prior to
working with a student.

Kihei Charter School Internship Program
300 Ohukai Rd. Suite 209| Kihei, HI 96753
808-870-0700

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● Blogs
All students are required to document their internship experience through
blogs. In order to receive credit, you must write a total of 10 blogs
that are due on the first day of class. All blogs must be done of Blogger
through your KCS gmail account. Please read Guidelines for Creating your
Blog for more details

● Time Logs
You must complete a minimum of 60 hours. All students must document their
internship hours. This can be done using the time log or if your internship site
has another method of tracking hours, that may be used. The time log MUST
BE SIGNED by your mentor and handed in on the first day of class in
order to receive credit.

● Evaluations and survey
At the end of your internship, there are two evaluations that the student must
hand in.
One is the evaluation of the intern’s work by the mentor and student You
must make sure to give your mentor their final evaluation AND COLLECT it
BEFORE leaving your internship.
The second is an internship survey evaluation of your experience as an
intern.

Follow-up
All students who complete their internship over the summer are required to submit
a complete packet of documentation at the beginning of the following school year.

Internships and Senior Projects
Internships can provide valuable insights into college and career choices . The best
senior projects are often closely related to a student’s internship.

Kihei Charter School Internship Program
300 Ohukai Rd. Suite 209| Kihei, HI 96753
808-870-0700

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KIHEI CHARTER SCHOOL
PO Box 1098
Kihei, HI 96753
808-875-0700
808-874-6745 (fax)

March 10, 2017

Dear Parent or Guardian:

As you know, senior year will be an exciting and busy time for KCS students. One of
the unique requirements our juniors will meet this summer is to complete an
internship that connects with and supports next yearʻs senior project. This is one of
the things that helps our students stand out from the rest when they apply for
colleges, jobs, scholarships, and other post-high school opportunities. We also hope
it will help students begin to develop their professional skills and interests, and a
level of comfort in working with adults and advocating for themselves in the world
outside of school.

To ensure the safety of our students as they participate in off-campus activities, we
require background checks of all mentors, just as we do for staff and other
volunteers who work directly with students. We also need written permission for
your teen to participate in the internship experience. Please read the official
language below and sign and return this form to their junior seminar leader, so that
your teen may begin her/his internship process. If you have any questions, ideas, or
concerns (or if you are interested in becoming a mentor), please contact me at
rhogeboom@kiheicharter.org.

Mahalo,

Richard Hogeboom, PhD
Internship Coordinator

I grant permission for _________________________________ to participate in out of
school activities, and to travel by means of transportation as required for the
approved internship. In the case of illness or injury to said student, I hereby consent
and authorize such medical or dental treatment as deemed necessary, and agree to
pay for such medical and dental costs, if incurred. I hereby release Kihei Charter
School and all adult leaders from any liability and from any and all claims against
them, individually or collectively, for any injuries which might be received during
Kihei Charter School Internship Program
300 Ohukai Rd. Suite 209| Kihei, HI 96753
808-870-0700

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internship activities, or in traveling to and from such internship activities.

_________________________________________
_________________________________
Parent/Guardian Signature Printed Name

_______________________________________________
Date

Summer Internship Approval
Form
Students, please complete this form along with your parent permission form prior to
meeting with your junior seminar instructor to get approval for your summer
internship.

What are the goals of your summer internship? (ie, what do you hope to
learn and how do you hope it will help you in your college/career planning
and year-long senior project?)

What is the internship you hope to complete this summer?
Please list the names of the company or organization and a little about what they do

Kihei Charter School Internship Program
300 Ohukai Rd. Suite 209| Kihei, HI 96753
808-870-0700

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What do you think you will you be doing?
Please describe your daily work and who you will be working with

How do you hope this will connect with your senior project?
You do not need to know your senior project to answer this question

Kihei Charter School Internship Program
300 Ohukai Rd. Suite 209| Kihei, HI 96753
808-870-0700

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Kihei Charter School Internship Setup
Form
The purpose of the setup form is to outline the details of your internship. This form
should be completed prior to you starting your internship and should be completed
after a meeting with your mentor. Please fill out this form completely!

Student Name
___________________________________________________________________________________

Mentor Contact Information
Please fill out this information completely

Mentor Name Company Name

Company Address Phone

Email Website

Schedule and Work Assignment
Please be as detailed as possible

Start Date (mm/dd/yyyy)

Days (ex. Mon, Tues & Thurs)

Hours (ex. 8:00am - 1:00pm)

Anticipated End Date (mm/dd/yyyy)

Daily Responsibilities

Kihei Charter School Internship Program
300 Ohukai Rd. Suite 209| Kihei, HI 96753
808-870-0700

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Logistics and transportation

How will you get to your internship?

What are your plans for meals and breaks?

Goals and Professionalism
Please be as detailed as possible

What do you hope to learn and accomplish at your internship?

What specific things would you like your mentor to help you work on or learn?

What are the requirements for professional dress?

Are there any other professional requirements that you need to follow?

Is there anything else you and your mentor need to discuss (safety procedures,
etc.)?

Kihei Charter School Internship Program
300 Ohukai Rd. Suite 209| Kihei, HI 96753
808-870-0700

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Mentor Background Check Form
Thank you for supporting one of our seniors by providing an internship opportunity. We could not do
the work we do without your support. Because we are a public education institution, we are required
to perform a check of criminal and sex offender records of any adult working with our students. By
providing the requested information and signing below, you are empowering Kihei Charter School (KCS)
to be your designated representative for the purpose of obtaining your criminal history record
information maintained by law enforcement agencies. In addition to the written information, we will
also need a copy of your government issued photo ID. Please contact Richard Hogeboom or Cheryl
Zarro if you have any questions or concerns about the background check process or check the
frequently asked questions (FAQs) attached to this document.

Mentor Name (Please write your full name. Name should match your photo identification)

_____________________________________________________________________________________

Address_____________________________________________________________________

_____________________________________________________________________________________

Gender___________ Date of Birth____________ Social Security No. __________________

Phone number____________________________

Email__________________________________

_____________________________________________________________________________________
Signature Date

Kihei Charter School Internship Program
300 Ohukai Rd. Suite 209| Kihei, HI 96753
808-870-0700

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Please complete this form and return it in the enclosed envelope along with a clear
photocopy of a government issued ID

Frequently Asked Questions
The following are frequently asked questions about the our background check process

Q. Why do mentors have to do background checks if they are not employees of the school?
A. Public educational institutes are required to check the backgrounds of all employees AND volunteers
that work directly with students. In our case, each year, we send more than 50 students to work one-
on-one with volunteer mentors in the community. We are able to do this because we follow the same
policies and procedures with our mentors as we do with volunteers who work within the schools. As a
result, you get the flexibility and benefit of an intern who can support your organization at your
convenience and students get an amazing learning experience.

Q. Who sees the information on this form?
A. The ONLY person who sees this form once you fill it out and return it in the enclosed envelope is
Cheryl Zarro, our HR administrator, or Raquel Balasan, also in HR.

Q. How is the information on the form used?
A. Once Cheryl receives your completed form with a copy of your photo ID, the information is entered
into ECRIM, the Hawaii Justice Data Center. You can access the site yourself here
https://ecrim.ehawaii.gov/. This is the same site that all government agencies use.

Q. What happens once an ECRIM report is run?
A. Once your information is entered, the ECRIM report is kept in our volunteer files for the duration of
an internship. You will only hear from us if there are any questions or concerns. Otherwise, that is the
end of the process.

Q. What if I already have an ECRIM or other background check report? Can I submit that?
A. Yes, absolutely! If you have an ECRIM or other background check report that has been completed
within the last year, you may submit that to the Internship Coordinator.

Q. Can I run the ECRIM report myself?
A. Yes, you can. There is a cost associated with running the report which is why the school does it for
you. However, if you are more comfortable obtaining the report and submitting it, that is also an
option. Directions on how to do this can be found right on the Hawaii Justice Data Center website.
https://ecrim.ehawaii.gov/

Have additional questions? Please contact your Junior Seminar Teacher.

Kihei Charter School Internship Program
300 Ohukai Rd. Suite 209| Kihei, HI 96753
808-870-0700

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Kihei Charter School Internship Program
300 Ohukai Rd. Suite 209| Kihei, HI 96753
808-870-0700

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Approved Summer Internships List
Below is the list of approved summer internship programs. Please check with Ms.
Hogeboom if you wish to add an internship to this list.

1. Macaleigh Hendricks - Akaku - February 1, 2017 (Mentor approved)
2. Xxxxx
3. X
4. X
5. X
6. X
7. X
8. X
9. X
10.X
11.X
12.X
13.X
14.x

Kihei Charter School Internship Program
300 Ohukai Rd. Suite 209| Kihei, HI 96753
808-870-0700

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Blog Guidelines
Your internship blog is one way you will document your experience at your
internship and throughout the school year. You will also use your blog to document
parts of your senior project. The blog is meant to capture things you’ve learned and
should not be a list of your day to day tasks although those details may also be
included. Please read below for complete blog guidelines.
Setting up your Blog
Your blog must be setup using Weebly, WIX or an approved site that can link to your
Senior portfolio and exit interview plans.
1. Once you blog is created, please make sure to make sure it’s public or
you add me as a reader so I can access your entries.

What to Write
Here are some directions on what to put in your blogs:

1. You must have 10 blog entries by the end of your internship. Your
10th blog should be a reflection of your internship experience. Please see
below for details on what to include in your final reflection
2. Each of your blog entries should be at least 2- 3 paragraphs long. You
can start your blog from your very first meeting with your mentor.

3. Blog entries should capture what you’ve learned and experienced at
your internship. A great way to demonstrate or exhibit learning and
experiences is through interactive blog posts. Tell a story about what
happened that day, a person you interacted with or a lesson you learned.
Maybe something you’re doing at you’re doing at your internship is
supporting you project, write about it. Think of your blog as a digital
scrapbook of your internship experience and your project development.
Including pictures, videos, maps and other visuals will help enhance your
evidence of learning.

4. Do not complete all your blog entries at one time. You should be
working on blog entries throughout your internship. FACT: Waiting until the
end of your internship to start your blogs is one of the biggest
reasons why students do not pass internships class. Don’t be that
person.
Kihei Charter School Internship Program
300 Ohukai Rd. Suite 209| Kihei, HI 96753
808-870-0700

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5. Final Reflection Blog Entry You must complete a minimum one page
(typed, single spaced, size 12 font) blog entry/essay reflecting on your
internship experience. Please make sure your final reflection is a high-quality,
well-crafted, finished piece of work. This is a very important part of your
internship and can impact whether or not you receive credit for your time and
efforts at your internship.

Your entry must address the following questions:
● What have you learned through your internship
experience?
● How did you use and expand your 21st Century Skills?
● How did you meet your personal internship goals? If you
did not meet them, why didn’t you accomplish what you had hoped?
● What were the most valuable aspects of this experience?
● What were the greatest challenges?
● How has this experience changed you?
● How and why has this experience helped to prepare you
for life after high school?
● What would you change if you had this experience to do
all over again?
● What advice would you give you future interns?

6. Share your blog with the internship coordinator, your mentor and
anyone else that you feel should see the great work you’re doing.

7. Your blog will be an integral part of internships and projects class
throughout your junior and senior years.

Kihei Charter School Internship Program
300 Ohukai Rd. Suite 209| Kihei, HI 96753
808-870-0700

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INTERNSHIP TIME LOG
Student Name: ______________________________________________Grade: ____________
Internship Site:
____________________________________________________________________
Internship Supervisor __________________________________

Date Time In Time Out Total Time Supervisor’s
Signature

TOTAL HOURS WORKED (60 minimum required): ______________________

INTERNSHIP SUPERVISOR SIGNATURE: _______________________________ Date:
_________

Kihei Charter School Internship Program
300 Ohukai Rd. Suite 209| Kihei, HI 96753
808-870-0700

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Kihei Charter School Internship Program
300 Ohukai Rd. Suite 209| Kihei, HI 96753
808-870-0700

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Internship Final Evaluation
Successes

Mentor Comments
____________________________________________________________________________
____________________________________________________________________________
____________________________________________________________________________
____________

Student Comments
____________________________________________________________________________
____________________________________________________________________________
____________________________________________________________________________
____________

Challenges

Mentor Comments
____________________________________________________________________________
____________________________________________________________________________
____________________________________________________________________________
____________

Student Comments
____________________________________________________________________________
____________________________________________________________________________
____________________________________________________________________________
____________

Other Thoughts

Mentor Comments: _____________________________________________________
___________________________________________________________________________

Student Comments: ________________________________________________________
____________________________________________________________________________

___________________________ _________ ____________________________ ________

Kihei Charter School Internship Program
300 Ohukai Rd. Suite 209| Kihei, HI 96753
808-870-0700

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Mentor Signature Date Student Signature Date

Internship Final Survey (online)
Name *
Name of Internship *
Mentor Name *

Internship Feedback

How would you rate your internship experience
overall? *
○ Excellent
○ Fair
○ Good
○ Poor
What was the best thing about your internship? *
What could have been better about your internship
experience? *
How did you like working with your mentor? *
Please explain why
Would you recommend this internship for another
student? *
Why or why not?
Please use this space to provide any additional
remarks or suggestions *

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Kihei Charter School Internship Program
300 Ohukai Rd. Suite 209| Kihei, HI 96753
808-870-0700

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Kihei Charter School Internship Program
300 Ohukai Rd. Suite 209| Kihei, HI 96753
808-870-0700

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Kihei Charter School Internship Program
300 Ohukai Rd. Suite 209| Kihei, HI 96753
808-870-0700

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