Agency Internship Opportunity

Agency Internship Opportunity Form

Please submit one form for each internship opportunity.
(If you are not submitting this form, click on the Close button.)

Your position(s) will be posted to both the Institute for Public Health website and the GSPH listserv. Students will contact your agency directly to apply.

If you have any questions please contact us.

Background Information

*Indicates Response Required

*1. Name

*2. Title

*3. Organization

If other, please specify

*4. Division/Department within Organization

*5. Mailing Address 1

Address 2

*City

*State

*Zip

*6. Work Phone Number (including area code and extension if applicable)

*7. Email

Information About Internship Position

*8. Number of Students Needed for This Internship

*9. Department or Division

*10. Name and Title of person who will be the primary supervisor of the intern(s)

	Supervisor Name	Supervisor Title

11. Briefly describe the project (not the specific activities of the intern). Please leave blank if unknown.

*12. Please describe the most important activities the intern(s) would be performing.

*13. Please describe the qualifications the intern(s) requires.

*14. How many hours per week do you need a student intern?

*15. During what months will you need an intern?
(e.g., May through August; Summer only; etc)

*16. Are there funds within your organization or department to provide partial or full support for this internship?

If so, how much?

*17. Does this position require the student to purchase Professional Liability insurance?

*Indicates Response Required

Institute for Public Health
Graduate School of Public Health
San Diego State University

http://iph.sdsu.edu