/ Texas Workforce Commission
Vocational Rehabilitation Services
Project SEARCH Internship Report
Instructions
  1. Describe the services provided by the Skills Trainer and/or by the Project SEARCH team;
  2. Record the Customer’s performance, as it relates to each question;
  3. Write the narrative responses in paragraph form in clear and descriptive English, leaving no blanks, and enters N/A, if not applicable;
  4. Obtain signatures;
  5. Complete the form electronically (on the computer), making certain all questions and all applicable standards have been met before submitting by fax, encrypted email, or mailing with an invoice for payment.

CustomerIdentification Information
Customer’s name: / VRSCase ID:
Serviceauthorization (SA) number:
Submitted for (enter X to select):
Project SEARCH internship rotation: One Two Three
Project SEARCH Internship Rotation Demographics
Host business’s name:
Description of internship rotation:
Start date: / End date:
Host business supervisor’s name: / Host business supervisor’s job title:
Host business supervisor’s phone number:
()
Host business supervisor’s email address:
School district contact’s name: / School district contact’s job title:
School district contact’s phone number: ()
School district’s contact’s email address:
Skills Trainer’s name: / Skills Trainer’s job title:
Skills Trainer’s phone number: ()
Skills Trainer’s email address:
Evaluation of Soft and Hard Skills
In the following tables, record the Customer’s performance for each skill using the scale below:
Score / Description
E / Exceptional: Performance far exceeded expectations because of the exceptionally high quality of work.
EE / Exceeds expectations: Performance consistently exceeded expectations.
ME / Meets expectations: Performance consistently met expectations, at times possibly exceeding expectations.
I / Improvement needed: Performance did not consistently meet expectations.
U / Unsatisfactory: Performance was consistently below expectations. Significant improvement is needed.
Essential Soft Skills to Be Demonstrated
Social Behavior / Score: / Comments, if any:
Handles stress
Makes eye contact
Refrains from unnecessary social interactions
Admits mistakes
Cooperative and courteous
Communication / Score: / Comments, if any:
Listens and pays attention
Expresses personal needs
(restroom breaks, doctors’ visits, etc.)
Respects the rights and privacy of others
Asks for help and clarification as needed
Communicates adequately
(that is, initiates conversation, does or does not interrupt, and so on)
Appearance / Score: / Comments, if any:
Maintains clean appearance
Dresses appropriately for the job or internship
Attends to personal hygiene
Job Performance / Score: / Comments, if any:
Follows directions
Accepts constructive criticism and/or feedback
Follows rules and regulations
Completes tasks accurately
Arrives on time and leaves on time
Attends to job tasks consistently
Works at appropriate rate
Initiates new tasks
Works well with co-workers
Follows proper chain of command
Problem solves and/or makes decisions
Essential Hard Skills to Be Demonstrated
Indicate the hard skills, job skills, and job-related responsibilities observed, as they relateto the internship position for this rotation. / Score: / Comments, if any:
Internship Attendance
Instructions:
  • For each week of the internship rotation, enter the dates from Monday through Sunday in the date column.
  • For each day of the internship, record the dates that the Customerattended the internship rotation.
If the Customer is present for the internship, record a P.
If the Customeris absent from the internship, record an A.
  • Total the number of days that the Customer attended the internship rotation.

Week / Date
(Mon-Sun) / Monday / Tuesday / Wednesday / Thursday / Friday / Saturday / Sunday
1
2
3
4
5
6
7
8
9
10
11
12
Total attendance: days out of days of the internship attended.
Summary of the Customer’s Internship Rotation Experience
Describe how the Customer has adjusted to his or her internship rotation, including any problematic issues or concerns that emerged and how they were addressed by the provider, host business, school district, long term support organization, and Customer:
Describe the Customer’s performance related to the essential and non-essential responsibilities of the internship rotation:
Describe any accommodations, compensatory techniques, and special training needs that were identified or established during the internship by the Project SEARCH team.
Describe the training related to teaching soft and hard skills that the Skills Trainerprovided.
Describe any consultations made with the internship’s host business:
Additional Information
Is the DARS3371, Project SEARCH Progress Log attached? / Yes No
Additional comments, if any:
Signatures
Customer’s signature
X / Date:
Customer’s legally authorized representative’s signature, if any:
X / Date:
Provider Qualifications
Type of Provider: / Traditional-bilateral contractor
Qualifications / Proof of Qualification / Verified by TWS-VRS
Specify UNTWISE Credential:
/ UNTWISE Credential Number: if no, DARS3490-Waiver Proof Attached / Yes No N/A
Specify UNTWISE Endorsement:
N/A / UNTWISE Endorsement Number: / Yes No N/A
Select: RID BID
SLIPI N/A / RID/BID/SLIPI Number:
Proof Attached / Yes No N/A
Other: / Number: Proof Attached / Yes No N/A
Job Placement Specialist signature
By signing below, I, the Skills Trainer, certify that:
  • the above dates, times, and services are accurate;
  • I personally completed the Internship Report collecting information about the Customer through direct services and as appropriate, the Customer’s internship mentors and Project SEARCH support team;
  • the Customer’s and/or Customer’s legally authorized representative’s signature on this form was gained on the date stated in the date field of the form;
  • I handwrote my signature and the date below; and
  • I maintain qualification as stated in the Standards or Service Authorization for the services provided and documented on this form.

Skills Trainertyped name: / Skills Trainer signature:
X / Date:
Director Credentials and Signature
Required for Traditional-Bilateral Contractors
By signing below, I, the Director, certify that:
  • I handwrote my signature and the date below; and
  • I ensure that the staff meets the qualifications and met the requirements in the Standards for Providers when delivering the service and;
  • I maintain the staff qualifications, including the UNTWISE credential, required for a Director, as described in Standards for Providers and/or Service Authorization.

Qualifications / Proof of Qualification / Verified by TWS-VRS
Specify UNTWISE Credential: / UNTWISE Credential Number: if no
DARS3490-Waiver Proof Attached / Yes No N/A
Director’s typed name: / Director’s signature:
X / Date:
If unable to verify the credentials, complete the following:
  • Enter the date a copy of the submitted invoice, report and DARS3460 was sent to provider to notify the staff did not meet the qualification as defined in the Standards for Providers and/orSA.
Date:______
  • Enter the date a case note was made to document the return of invoice and required form(s)
Date: ______
Date Form Submitted by Provider:
Date Form Received by TWS-VRS Office:
If any question above is answered “No,” complete the following:
  • Send a copy of the submitted invoice and the report to the provider with the DARS3460 to notify the provider the service delivery or report did not meet the requirements as described in the Standards for Providers and/orSA Date:

  • Record a case note to document the return of invoice and required form(s) Date:

Report: Approved Sent back to provider
Comment (if any):
Printed name of VRS staff member making verifications: / Date verified:

DARS3372 (10/17) Project SEARCH Internship Report Page 1 of 7