Application Form | Health Sciences Internship

All fields on this form are required, be sure you have all the information before you begin.

Internship Application

Student Information

Name *

First

Last Name *

Last

Phone *

OSU Email Address *

Number of credit hours *

Maximum three hours per semester. Note that each credit hour of the course requires 45 hours of documented internship experience.

Semester of internship *

Internship Information

Internship site *

Preceptor's name *

First

Last Name *

Last

Preceptor's job title *

Preceptor's email address *

Preceptor's phone *

Address of internship *

Address of internship

City

State/Province

Zip/Postal

Country

Start date *

End date *

Provide a brief description of the organization. What is the primary mission/function of the organization? *

Provide a brief overview of your proposed internship responsibilities and activities. *

Internship Guidelines

By clicking submit, I indicate that I understand I must fulfill all duties as they pertain to the internship and complete all assignments outlined in the syllabus in order to successfully complete the Internship in Health Sciences. I further indicate that the terms of the internship have been agreed upon by the preceptor and me.

If you are human, leave this field blank.

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