This application must be completed and turned in the semester before the internship would take place. Please circle the semester and fill in the year for which you are applying.

Please review the list of internships for any requirements specific to the internships for which you are applying. All applicants must meet the requirements and accept the responsibilities below:

Requirements:

• GPA (overall) Allopathic/Osteopathic 3.0, All others 2.6 
• Must have had an active file in the Preprofessional Health Advising Office prior to the semester in which you are applying. 
• Completion of lower division writing competency requirement
• Consent of Instructor

• 60 hours minimum (reported by the facility) are required for credit
• 10 page research report reviewing a disease or condition encountered during the internship 
• Written evaluation (1/2 page minimum, single spaced) of your experience in the internship 
• Must be enrolled in Bio 348 for credit. (Complete a Special Studies form and request an add code.) 

Please review the list of internships available for the semester for which you are applying. If your choice is an ¹⁾"On Your Own" internship, complete all areas of this application. If your choice is for one which is offered by the PPHA office, complete all areas of this application except those indicating ¹⁾ "On Your Own".
 
 

Name___________________________________ Address __________________________________ __________________________________ Telephone ( ...)_______________________ Science GPA__________ # of units _____ Nonscience GPA_________ # of units _____  Cumulative GPA_________# of units ______ Email address:_________________________________

First Choice:__________________________ Second Choice: ________________________ Third Choice: __________________________ If my first three choice are not available, I would be willing to take any of the other internship offerings:  Yes............No (circle one)

Anticipated date of graduation ____________ Major_______________ 

Year you would be matriculating to professional school: ________.

What honors have you received while in college?

 

1. 2. 3.

4. 5. 6.

In the space below, state concisely why you would like to be considered for a clinical internship.
 
 
 

Students applying for an internship sponsored by the PPHA Office may skip the following but must sign and date the application at the bottom of the page.

On Your Own Internship Information

NOTE: This application must contain the following information before it can be considered.

Facility_________________________________ Name of Supervisor ______________________

Address_________________________________ Phone Nbr.__________________________
 

On Your Own Internship Information NOTE: This application must contain the following information before it can be considered. Request your supervising personnel to write and sign the brief description, in the space provided below, explaining what your duties will entail during the internship.     ______________________________________ Print Name ___________________ Print Date ______________________________________ Signature

To be completed by all students: I have read and understand the requirements and responsibilities of applying and accepting an internship position as described above.
 

__________________________________ Name

____________________ Date