New Agency Information Form

Agency Name*

Address*

Street Address

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Postal / Zip CodeCountry

Setting*

Populations Served*

Name*

First NameLast Name

Title*

Phone Number*

Fax Number

E-Mail*

CTRS Certification Number

CPRP Certification Number

Resume*

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The Texas State University Recreation Division requires students to complete a minimum 200 hours for fieldworks, a minimum 400 hours for Recreation Administration internships, and a minimum 560 hours for Therapeutic Recreation internships. Students are required to work a minimum 20 hours and a maximum 45 hours per week. For Therapeutic Recreation certification, interns must be supervised by a full-time CTRS over a minimum of 14 consecutive weeks. If your agency cannot guarantee students the minimum required hours, please do not request/accept fieldwork or internship students.

Minimum Hours Acceptance*

Agency requires more than minimum hours.Agency requires more than minimum weeks.Agency accepts the University minimums.

If your agency requires more than the University minimum hours or weeks, please specify agency minimum(s).

Minimum Hours

Minimum Weeks

The University allows students to complete fieldworks (200 hours) and Recreation Administration internships (400 hours) in the fall, spring, and summer semesters; students may only complete Therapeutic Recreation internships (560 hours) in the fall and spring semesters. Please select the semester(s) in which your agency will be willing to accept fieldwork and/or internship students.

Fieldwork Students*

Fall (August - December)Spring (January - May)Summer (May - August)

Internship Students*

Fall (August - December)Spring (January - May)Summer (May - August)

Listed below are types of experiences appropriate to the different fieldwork and internship levels. Some experiences are common to all levels. Please select all experiences that your agency would be able to offer students at each level.

REC 2336 Leadership & Programming Fieldwork

REC 4680 Internship

To further indicate the types of experiences students will gain with your agency, please upload a job description for each fieldwork and internship position.

Job Description*

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Each agency is expected to communicate fully to students what requirements they must fulfill before beginning their field experience. Please select all requirements that your requires students to fulfill before being accepted to/beginning work with your fieldwork/internship program.

Please indicate the general work schedule that will be expected of students.

Typical Work Schedule*

Average Work Week for Fieldwork Position(s)*

15 hours20 hours40 hoursMore than 40 hours

Average Work Week for Internship Position(s)*

20 hours40 hoursMore than 40 hours

Please indicate whether you are interested in accepting fieldwork and/or internship students beyond the specific student you have accepted for the upcoming semester.

Yes, I am interested in accepting other students in the future.No, I only plan to accept this specific student.

Please upload any additional informational or promotional documents, such as an internship packet, program schedule, or agency brochure.

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Texas State University Recreation Division

Supervisor Information

Minimum Hours Requirements

Student Experiences Offered

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