Internship Supervision Form
(completed by the eampusidistit supervisor)
Lagree to serve as the Administrator Supervisor for WE eite Love
[understand that my responsibilities include the following:
1. Supervising the intern during the field experiences noted in the syllabus,
such as but not limited to the following: facilitating access to campus or
district personnel, allowing the intern to shadow me or a fellow
administrator, validating the intern’s activity log.
2, Assisting and guiding the intern as problems may arise in completing the
specified field experiences.
3, Evaluating the intern at the end of the internship.
strative supervisor_ NQtA\ie, Beuitt [ike
Title: Sear Manager Special Educects on
Date: 1/29]2,
Phone Number: “119-434-4790
Email address: _Aprut@nossimaisd org
School/Institution: Special Edu
Address: 0.
zip: ods
EDUC 6330 Administrative Internship
Dr. Virginia Leiker
School of Education
University of St. Thomas
3800 Montrose Boulevard
Houston, Texas 77006