Forms

Below is a grid of important forms for the Internship and Special Project:

Click on the form name to open a pdf file of the form.

NOTE:  Recently we have had reports of issues viewing and completing the pdf forms in Google Chrome.  Mozilla Firefox and Microsoft Internet Explorer currently are better options for viewing and filling out the forms.

Internship Questionnaire

This form is to be completed by students early in the semester before their internships and submitted to the internship Coordinator. It intended to assist students in identifying internship opportunities.

Internship and Special Project Proposal

This form is to be completed by the student intern and submitted to Internship Coordinator after having obtained signatures from the faculty advisor and the preceptor.  Students will be registered for internship credits only with an approved proposal.

Preceptor Evaluation

This is to be completed by agency preceptors as an evaluation of the students’ internship performance. Agency preceptors will receive an email from the internship and outreach coordinator providing the Qualtrics link to complete the evaluation. The program requests that it is completed as soon as possible after the conclusion of the internship

Internship Time Log

This form must be used to log your internship hours. The form must be completed by the student and signed by the preceptor.

 Internship Evaluation

This form is to be completed by the student intern as a means to evaluate their internship experience. It can be filled out electronically and click “submit” at the bottom of the page no later than Public Health Day.

Special Project Presentation Assessment Form

This form is completed by faculty to evaluate student oral and poster presentations on Public Health Day.