Parent & Guardian Statement

To Parent(s)/Guardian(s)

Internship Year generally requires students to be dependable and prompt, to work independently and in groups and to communicate clearly with supervisors, peers and Dynamy staff. For more detailed information about Dynamy Internship Year, please review our website (Internship Year) or call the Director of Admission (508-755-2571). We greatly appreciate your willingness to provide a frank and prompt appraisal of the applicant.

Applicant’s Name

Parent/Guardian’s Name

Parent/Guardian’s Email

Short Answers

What are the applicant’s strengths?

What are the applicant’s challenges?

What goals would you set for the applicant’s Internship Year?

How would you describe the applicant’s learning style and optimal learning or work environment?

Internship Year Skills Assessment

How would you describe the applicant’s abilities in the following categories?

(please check one box for each skill and briefly describe the applicant’s abilities in those categories where you’ve checked either “strength” or “challenge”)

  Strength Neither Strength nor Challenge Challenge
Organizing Belongings  Strength  Neither Strength nor Challenge  Challenge
Scheduling Time  Strength  Neither Strength nor Challenge  Challenge
Prioritizing Tasks and Goals  Strength  Neither Strength nor Challenge  Challenge
Completing Tasks on Schedule  Strength  Neither Strength nor Challenge  Challenge
Creatively Solving Problems  Strength  Neither Strength nor Challenge  Challenge
Communicating with Peers  Strength  Neither Strength nor Challenge  Challenge
Communicating with Older Adults  Strength  Neither Strength nor Challenge  Challenge
Contributing Positively to Groups  Strength  Neither Strength nor Challenge  Challenge
Reflecting on Past Experiences  Strength  Neither Strength nor Challenge  Challenge
Accepting Feedback  Strength  Neither Strength nor Challenge  Challenge
Providing Feedback to Others  Strength  Neither Strength nor Challenge  Challenge

Optional – Supplemental Information


I have reviewed this completed application including the completed Personal Questionnaire above. I certify that all of the statements made in this application are true, correct and complete, to the best of my knowledge, and are made in good faith. I understand that misinformation or omission of information could result in disqualification and/or termination of the applicant’s enrollment in Dynamy Internship Year. I am unaware of any further medical, psychological or physical conditions that might inhibit the applicant’s ability to fully participate in the program.

I hereby certify the above

Parent’(s)/ Guardian’s Name