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Viterbo University-Iowa Center – Educational Leadership Program
Viterbo Educational Leadership: Internship Log © 2010 1
Internship Log – Educational Leadership Program
Name: _________________________________________ Semester: _Circle one: SUMMER FALL SPRING__ Year: ____________________________________________
*Candidates should review syllabi and Matrix for Iowa Standards for School Leaders and Corresponding Activities and Assessments for required clinical hours directly related to courses.
**Candidates must plan with Mentors, Internship Supervisors, and Advisors to assure that clinical experiences in internship develop candidate’s entry-level mastery in each of the standards.
*** Candidates are required to reflect on activities/projects using the required reflection form, and indicating the number of the reflection.
****Mentors and Internship Supervisors will initial logged activities/projects after review and discussion with candidate.
Date Clinical
Hours
Summary of
Specific Activity/Project
Conceptual Framework:
Belief Statements
Iowa Standards for
School Leaders
Level of
Education
Diverse Learners
District
Size
Reflection
Number
***
Initials Mentor/
Supervisor
****
400
In
tern
ship
Ho
urs
w/
10
0 h
ou
rs i
n
Sp
ecia
l E
du
cati
on
**
100
Ho
urs
of
Req
uir
ed
Co
urs
e-R
ela
ted
Cli
nic
al
Ex
per
ien
ces
*
Is v
isio
na
ry a
nd
coll
ab
ora
tiv
e
Is a
ref
lect
ive
dec
isio
n
ma
ker
(C
on
tem
pla
tio
n)
Ha
s re
spec
t fo
r h
um
an
dig
nit
y a
nd
div
ersi
ty
(In
teg
rtiy
)
Is s
tud
ent
cen
tere
d f
or
bo
th c
an
did
ate
s an
d
pu
pil
s
Is a
n e
ffec
tiv
e
inst
ruct
ion
al
lea
der
wh
o
bel
iev
es a
nd
ex
pec
ts a
ll
stu
den
ts c
an
an
d w
ill
lea
rn
Pro
vid
es se
rvic
e to
hu
ma
nit
y (S
erv
ice)
I: S
ha
red
Vis
ion
II:
Cu
ltu
re o
f L
earn
ing
III:
M
an
ag
emen
t
IV:
Fa
mil
y &
Co
mm
un
ity
V:
Eth
ics
VI:
S
oci
eta
l C
on
tex
t
Pre
-Kin
der
ga
rten
Ele
men
tary
Mid
dle
Sch
ool/
Jr
Hig
h
Hig
h S
cho
ol
Lo
w S
oci
o-E
con
om
ic
Sta
tus
(Lo
w S
ES
)
Sp
ecia
l E
du
cati
on
(IE
P)
Req
uir
ed 1
00
ho
urs
Ta
len
ted
an
d G
ifte
d
En
gli
sh L
an
gu
ag
e
Lea
rner
s (
EL
L)
Ra
ce/E
thn
icit
y
Urb
an
(U
EN
8)
Inte
rmed
iate
(6
01
+ b
ut
no
t U
EN
)
Ru
ral
(60
0 o
r le
ss)
Example
6/15/11
Example
3.0
Example:
Review of disaggregated data of
high school math
X
X
X
X
X
X
X
X
X
2.0
X
X
X
X
1
aek
Example
10/10/10
Exampl
e
2.0
Example:
Development of Theory of
Change on Differentiated
Instruction (EDUC 806)
X
X
X
X
X
X
X
X
X
X
X
2.5
X
X
X
X
2
aek
Viterbo University-Iowa Center – Educational Leadership Program
Viterbo Educational Leadership: Internship Log © 2010 2
Date Clinical
Hours
Summary of
Specific Activity/Project
Conceptual Framework:
Belief Statements
Iowa Standards for
School Leaders
Level of
Education
Diverse Learners
District
Size
Reflection
Number
***
Initials Mentor/
Supervisor
****
400
In
tern
ship
Ho
urs
w/
10
0 h
ou
rs i
n
Sp
ecia
l E
du
cati
on
**
100
Ho
urs
of
Req
uir
ed
Co
urs
e-R
ela
ted
Cli
nic
al
Ex
per
ien
ces
*
Is v
isio
na
ry a
nd
coll
ab
ora
tiv
e
Is a
ref
lect
ive
dec
isio
n
ma
ker
(C
on
tem
pla
tio
n)
Ha
s re
spec
t fo
r h
um
an
dig
nit
y a
nd
div
ersi
ty
(In
teg
rtiy
)
Is s
tud
ent
cen
tere
d f
or
bo
th c
an
did
ate
s an
d
pu
pil
s
Is a
n e
ffec
tiv
e
inst
ruct
ion
al
lea
der
wh
o
bel
iev
es a
nd
ex
pec
ts a
ll
stu
den
ts c
an
an
d w
ill
lea
rn
Pro
vid
es se
rvic
e to
hu
ma
nit
y (S
erv
ice)
I: S
ha
red
Vis
ion
II:
Cu
ltu
re o
f L
earn
ing
III:
M
an
ag
emen
t
IV:
Fa
mil
y &
Co
mm
un
ity
V:
Eth
ics
VI:
S
oci
eta
l C
on
tex
t
Pre
-Kin
der
ga
rten
Ele
men
tary
Mid
dle
Sch
ool/
Jr
Hig
h
Hig
h S
cho
ol
Lo
w S
oci
o-E
con
om
ic
Sta
tus
(Lo
w S
ES
)
Sp
ecia
l E
du
cati
on
(IE
P)
Req
uir
ed 1
00
ho
urs
Ta
len
ted
an
d G
ifte
d
En
gli
sh L
an
gu
ag
e
Lea
rner
s (
EL
L)
Ra
ce/E
thn
icit
y
Urb
an
(U
EN
8)
Inte
rmed
iate
(6
01
+ b
ut
no
t U
EN
)
Ru
ral
(60
0 o
r le
ss)
Total
Viterbo University-Iowa Center – Educational Leadership Program
Viterbo Educational Leadership: Internship Log © 2010 3
SEMESTER 1:
Signature of Candidate: __________________________________________________ Date: _______________________________
Signature of Internship Supervisor: _________________________________________ Date: _______________________________
Signature of Mentor: ______________________________________________________ Date: _______________________________
SEMESTER 2:
Signature of Candidate: __________________________________________________ Date: _______________________________
Signature of Internship Supervisor: _________________________________________ Date: _______________________________
Signature of Mentor: ______________________________________________________ Date: _______________________________
SEMESTER 3:
Signature of Candidate: __________________________________________________ Date: _______________________________
Signature of Internship Supervisor: _________________________________________ Date: _______________________________
Signature of Mentor: ______________________________________________________ Date: _______________________________
SEMESTER 4:
Signature of Candidate: __________________________________________________ Date: _______________________________
Signature of Internship Supervisor: _________________________________________ Date: _______________________________
Signature of Mentor: ______________________________________________________ Date: _______________________________
Viterbo University-Iowa Center – Educational Leadership Program
Viterbo Educational Leadership: Internship Log © 2010 4
SEMESTER 5:
Signature of Candidate: __________________________________________________ Date: _______________________________
Signature of Internship Supervisor: _________________________________________ Date: _______________________________
Signature of Mentor: ______________________________________________________ Date: _______________________________
SEMESTER 6:
Signature of Candidate: __________________________________________________ Date: _______________________________
Signature of Internship Supervisor: _________________________________________ Date: _______________________________
Signature of Mentor: ______________________________________________________ Date: _______________________________