internapp

internapp - the internship learning objectives and proposed...

Info iconThis preview shows pages 1–2. Sign up to view the full content.

View Full Document Right Arrow Icon
UNIVERSITY OF GEORGIA - Master of Public Health Internship Approval – PBHL 7560 Semester of Internship: ± Fall ± Spring ± Summer Year: 200__ Credits: __ STUDENT IDENTIFICATION Name: UGA ID (not SS#) E-mail: Home Address During Internship: Home Phone Number: Cell Phone Number: SITE IDENTIFICATION Name of Organization: Type of Organization: Non Profit For Profit Gov’t Hospital Other Site Street Address Site Mailing Address Name of Supervisor: 1 Title of Supervisor E-mail (Supervisor): Phone (Supervisor): FAX (Supervisor): ****** The internship minimum requirement is 300 hours. ***** 1 If the supervisor changes during the course of the internship, the student must resubmit the proposal with new signatures. 1
Background image of page 1

Info iconThis preview has intentionally blurred sections. Sign up to view the full version.

View Full Document Right Arrow Icon
Signature Page My signature below indicates that I have discussed with the student
Background image of page 2
This is the end of the preview. Sign up to access the rest of the document.

Unformatted text preview: the internship learning objectives and proposed tasks, and that I agree with the proposed learning objectives and related internship activities. Student Signature: ______________________________________Date:_______ (SIGNATURE) Site Supervisor approval: ________________________________ Date:_______ (SIGNATURE) Academic Advisor approval: _____________________________Date: _______ (SIGNATURE) MPH Progr. Coordinator approval: _________________________Date:_______ (SIGNATURE) Original internship forms will be kept at the College of Public Health Dean’s Office: MPH PROGRAM COORDINATOR Ashley Wells, MPH, CHES N 122 A Paul D. Coverdell Center University of Georgia, Athens, GA 30602 Phone: 706.583.0059 FAX: 706.542.6730 Email: [email protected] 2...
View Full Document

{[ snackBarMessage ]}

Page1 / 2

internapp - the internship learning objectives and proposed...

This preview shows document pages 1 - 2. Sign up to view the full document.

View Full Document Right Arrow Icon
Ask a homework question - tutors are online