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.