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

Parent(s)/Guardian

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.

certify
I hereby certify the above

Parent’(s)/ Guardian’s Name

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