INTERNSHIP REPORT
For the Degree of
MASTER OF ARTS IN PSYCHOLOGY
(Industrial Psychology)
Name of the Learner :
Enrolment No :
Programme Duration : Jan 20-Dec 24
Programme Code : MAPC
Course Code : MPCE036
Study Centre :
Regional Centre code/name :
Name of Organisation : IGNOU
Mobile No :
Email ID of the Learner :
Place :
Date : 18 May 2023
DISCIPLINE OF PSYCHOLOGY, SOSS,
INDIRA GANDHI NATIONAL OPEN UNIVERSITY
MAIDAN GARHI, NEW DELHI – 110068
APPENDIX-I DECLARATION
I Ms. __________ hereby declare that I am a Learner of M.A. Psychology (Part II), January/
July year, at the Study Centre Code __________ Regional Centre __________and I want to do
my Internship (MPCE-035) at ................................................. on my own free will. I will
adhere to the standards of the organization and display professionalism during my internship.
Signature of the Learner Date:
Name of the Learner: Place:
Enrolment No:
APPENDIX-II FORMAT FOR REFERENCE LETTER
Date:
To,
Dear Sir/ Madam,
This is state that Ms. , Enrollment
No. is a student of IGNOU and is presently pursuing MA in
Psychology from Regional Centre , Study
Centre As a part of MA Psychology programme he/ she has to carry out
internship (MPCE-015/MPCE-025/MPCE-035) for 240 hours. You are requested to kindly
provide him/her with permission to undergo internship at your esteemed organization.
You are also requested to assign one supervisor under whom the learner will carry out his/ her
internship. The superviser will also have to evaluate the learner as per the given criteria.
Yours faithfully,
Academic Counsellor/Study-Centre Coordinator/Regional Director
APPENDIX-III CONSENT LETTER (Agency Supervisor)
This is to certify that the internship in MPCE-035 for the partial fulfillment of MAPC
Programme of IGNOU will be carried out by Mr./Mrs.
Enrollment No. , under my supervision.
(Signature)
Name of the Agency Supervisor:
Designation:
Address:
Date:
RECORD OF VISITS/ACTIVITIES CARRIED OUT BY LEARNER
Time Place NATURE OF Name & Assignments/
Date of Duration Visited WORK signature of Remarks
Visit Concerned
From To
Authority
19/08/21 4pm 7pm Online
Zoom
20/08/21 4pm 7pm Online
Zoom
23/08/21 4pm 7pm Online
Zoom
24/08/21 4pm 7pm Online
Zoom
25/08/21 4pm 7pm Online
Zoom
26/08/21 4pm 7pm Online
Zoom
27/08/21 4pm 7pm Online
Zoom
30/08/21 4pm 7pm Online
Zoom
31/08/21 4pm 7pm Online
Zoom
01/09/21 4pm 7pm Online
Zoom
02/09/21 4pm 7pm Online
Zoom
03/09/21 4pm 7pm Online
Zoom
0606 4pm 7pm Online
06/09/21 Zoom
4pm 7pm Online
07/09/12 Zoom
08/09/21 4pm 7pm Online
Zoom
09/09/21 4pm 7pm Online
Zoom
Note: This includes visit to the organisation/institute where the internship is carried out and
interaction with the academic counsellor allotted to the learner.
Signature of the Learner Signature of Academic Counsellor
APPENDIX-V EVALUATION SCHEME FOR INTERNSHIP— (AGENCY
SUPERVISOR)
Name of the Programme: Course Code:
Study Centre: Regional Centre:
Name of the Learner:
Enrollment No.:
Internal Marks by Agency Supervisor
Details Maximum Marks Marks Obtained
Sincerity and professional competence 10
Assessment (Case history, Mental 15
Status Examination, Interview,
Psychological Testing etc.)
Overall interaction with patients, clients & 5
employees and handling of cases
Total Marks 30
Comments, if any:
Signature
Name of Agency Supervisor
Date:
Note:
1. At the end of the Internship the marks are to be given by the Agency Supervisor in the
above format and is to be sent to the concerned study centre address in a sealed envelope.
2. The Study Centre will then send the marks given by the Agency Supervisor along with the
marks given by the Academic Counsellor to the Regional Centre while sending the
Intership Report of the Learners to the Regional Centre.
3. The marks given by the Agency Supervisor and the Academic Counsellor will be totalled
and entered in the Award Sheet during the TEE of the Internship at the·Regional Centre;
The total internal marks are 60.
APPENDIX-VI EVALUATION SCHEME FOR INTERNSHIP— (ACADEMIC
COUNSELLOR)
Name of the Programme: Course Code:
Study Centre: Regional Centre:
Name of the Learner:
Enrollment No.:
Internal Marks by Academic Counsellor
Details Maximum Marks Marks Obtained
Report 20
Provisional diagnosis and Planning of 5
Intervention
Overall Understanding of Cases 5
Total Marks 30
Comments, if any:
Signature
Name of Academic Counsellor
Date:
Note:
1. At the end of the Internship the marks are to be given by the Academic Counsellor.
2. The concerned Study Centre will then send the marks given by the Academic Counsellor
along with the marks given by the Agency Supervisor to the Regional Centre while
sending the Internship Reports of the Learners to the Regional Centre.
3. The marks given by the Academic Counsellor and the Agency Supervisor will be totalled
and entered in the Award Sheet during the TEE of the Internship at the Regional Centre.
The total internal marks are 60.
APPENDIX-VII EVALUATION SCHEME FOR INTERNSHIP (EXTERNAL
EXAMINER)
Name of the Programme: Course Code:
Study Centre: Regional Centre:
Name of the Learner:
Enrollment No.:
External Marks (Viva Voce)
Details Maximum Marks Marks Obtained
Viva 40
Total Marks 30
Comments, if any:
Signature
Name & Address of External Examiner
Date:
Note: The marks given by the External Examiner are to be entered in the Award Sheet along
with the internal marks received from the Study Centre at the time of TEE of Internship.
APPENDIX-VIII CERTIFICATE
CERTIFICATE
This is to certify that Ms./Mr. ___________ of MA Psychology Second Year (MAPC
Programme) has conducted and successfully completed the Internship in MPCE 015/ MPCE
025/ MPCE 035 (please tick one organisation/clinic/agency) in the place
Name: Name:
Enrollment No.: Designation:
Name of the Study Centre: Place:
Regional Centre: Date:
Place:
Date:
Signature of Agency Supervisor
Name:
Designation:
Name of the Organization:
Address:
Place:
Date:
APPENDIX-XI
ACKNOWLEDGEMENT
This is to acknowledge that Ms./Mr. .............................................................................................
Enrollment No. ........................................................ of MAPC (2nd Year) has submitted the
Internship Report at the Study Centre............................................................................Regional
Centre .................................................
Date: Signature (with stamp)
