ClaremontGraduateUniversity
MasterofPublicHealthProgram
SUPERVISEDFIELDTRAININGINTERVIEWFORM
INSTRUCTIONS:
StudentswillarrangeameetingwiththeSupervisedFieldTrainingCoordinatorinthesemesterpriortobeginningfield
traininghours.Responsestothefollowingquestionswillassistindevisingasearchstrategyforyourinternshipplacement.
Thisform,alongwithacurrentresume,shouldbee-mailedtopriortoyourmeeting.Itisadvisedthatstudentsfamiliarize
themselveswiththepoliciesandprocedurescontainedintheSupervisedFieldTrainingManualandPowerPointOrientation
Slidespriortothescheduledmeeting.
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Today’sDate:
Name&IDNumber:
Address:
Phone#:
E-mail:
Concentration:
Citizenship:
Languagesspoken:
1. Indicatecoursesthatarecompleted,in-progressorplanned.Placean“X”intheappropriate
category.
Note:Studentsareeligibletobeginfieldtraininghoursiftheyhavecompletedallcoreandconcentrationcoursesor
areinthefinalsemesterofcoursework.
Course
CGH300
CGH301
CGH302
CGH303
CGH304
CGH305
ConcentrationCourse1
ConcentrationCourse2
ConcentrationCourse3
ConcentrationCourse4
Elective
Completed
In-progress
Planned
2. Indicateyourpreferredscheduleconcerningyourfieldtraining.
Beginfieldtraininghours
Registerforfieldtrainingrequirement
Fall201_
Spr201_
Sum201_
3. Areyouapplyingforawaiver?(Seeinternshiphandbookforeligibilitycriteria.)
___Yes _____No
_____Unsure
4. Stateyourshortterm(6months–1year)andlong-term(upto5years)careergoals.
Unsure
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5. List(inrankorder)thetopthreepublichealthissuesorareasyouwouldliketoexplore
duringyourfieldtraining.
1.
2.
3.
6. Indicateyourlevelofinterest(high,medium,low,none)inthetypeofprofessionalsettings
youwouldliketobeplaced.Placean“X”intheappropriatecategory.
Setting
FederalHealthagency
Statehealthagency
Localhealthagency
University(non-research)
Researchpolicyinstitute
Communitybasedorganization
Corporation
Consultingfirm
Healthsystem(hospital,clinic)
Managedcare/HMO
High
Medium
Low
None
7. Indicateyourpreferenceforthelocationofyourplacement.Placean“X”inallareasyou
wouldconsider.
SouthernCalifornia
Specifyaparticularcity/county
OtherCalifornia
Specifylocation:
OtherUnitedStates
Pleasespecify:
International
Specifyregion/country
8. Listuptothreespecificorganizationsyouareinterestedinexploring.Placean“X”ifyouhave
madecontactwithanyoftheseagenciesandthecontactnameifknown.
AgencyName
MadeContact
ContactName
9. Doyouhaveanyofthefollowingcircumstancesthatmayimpactyourfieldtraining
experience?
____Childcare ____Transportation
____Currentemployment
___Location
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10. Indicatewhichskills/functionsyouhaveexperienceinorwouldliketodevelopinyourfield
trainingexperience.Placean“X”intheappropriatecategory.
Skills/Functions
HaveExperience
In
WanttoDevelop
Assessment
Researchanddatacollection
Dataanalysis
Questionnairedesign/administration
Keyinformantinterviews
Focusgroupdiscussions
Assessmenttools:development/selection/use
Planning
Presentationplanning
Planninginterventions
Developingcurriculum
Writinggrants
Planningconferences,meetings
Involvingstakeholdersintheplanningprocess
Implementation
Conductingapresentation
Directingandcoordinatingaprogram
Contacting/informing/collaboratingwithcommunityorganizations
Involvingmembersofthetargetgroup
Trainingstaff/volunteers
Preparing/disseminatingpromotionalmaterialssuchasnewsarticles,press
releases,radiospots
Evaluation
Formativeprogramevaluation:Design/conduct/analysis
Reviewinggrantproposals
Summativeprogramevaluation:Design/conduct/analysis
Evaluatingdatacollectioninstruments/programplans
Reviewingofeducationalmaterials
Computer/InformationSystems
Familiaritywithsoftware(statisticalpackages,databases,spreadsheets,desktop
publishing)
Familiaritywithgraphics(use,designanddevelop)
Familiaritywithsocialmedia
Webpagedesign
UseofGeographicalInformationSystems
UseofElectronicMedicalRecords
MaterialsDesign/Development
Designorproductionofprint/audio/visualmaterials
Pre-test/pilottestmaterials
Materialsdistribution
Translate/evaluatetranslationofmaterials
Evaluatematerialsforeducationaleffectivenessandculturalsensitivity
Policy
Conduct/analyzepolicyresearch
Developpolicylegislation/regulations
Advocateforpolicy
FiscalFunctions
Develop/managebudgets
Writebudgetjustifications
Financialplanning
Fundraising
CulturalCompetence
Understandone’sculturalbackgroundinrelationshiptoothers
Establishsensitiveandeffectiveworkingrelationswithdiversepopulations
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Skills/Functions
Designculturallyandlinguisticallyrelevantinterventionsandmaterials
Conductculturalsensitivitytraining
Management
Plan/organize/coordinate/monitorpeople&resources
Identify/analyze/solveproblems
Establishagenda/facilitatemeetings
Leadership
Lead/participateininterdisciplinaryteams
Provideinnovativeapproachestopublichealthproblems
Lead/engageincommunityorganization/mobilizationactivities
Develop/adheretoethicalstandards
Other
HaveExperience
In
WanttoDevelop