Forms (post-Fall 2019)

Internship Proposal

This form is completed by the student intern and submitted to the Internship Coordinator after obtaining the proper signatures. Only students with an approved proposal will be registered for internship credits.

Internship Work Plan

This form is completed by the student intern and submitted to the Internship Coordinator after detailing the work plan. Only students with an approved proposal will be registered for internship credits.

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 must be submitted no later than Public Health Day.

Public Health Service Timelogs

Students should be tracking their PHS hours throughout their time in the program.

Public Health Service Hours Factual Reports

Students should complete a factual report for each public health service opportunity.

Portfolio Work Product Assessment Rubric

This rubric is used by the Faculty Advisor to assess the work products submitted by the student.

Final PHC 6941 Portfolio Product Proposal Form

This form completed by the student at the start of their internship, outlining the portfolio work products they will develop during their internship. The faculty advisor signs off on this form before the student submits it to Canvas.

MPH Core & Concentration Competencies

This is a list of the MPH Core (and concentration) Competencies for reference. During their internship, students must address a minimum of 5 public health competencies, at least three of which must be MPH core competencies.