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Application due dates:
For Fall Internship - due May 1 of prior (spring) semester.
For Spring Internship-due December 1 of prior (fall) semester.

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.

(Fall) (Spring) Year_________

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:


  • 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.) 
NOTE: You must complete this application to be considered.

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".

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?

List medically related activities in which you have participated.

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

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.