Supervised
DrPH Practice-Based
Internship
Portions of this document must be completed in MS Word
and printed for appropriate signatures
For more information consult with your major professor(s).
Natalie D. Preston-Washington, MPA
Manager, Career Development and Field Placement
College of Public Health ▪ University of South Florida
13201 Bruce B. Downs Blvd, MDC 56 ▪ Tampa, FL 33612-3805
(813) 974-7714 ▪ (813) 974-8121 (fax)
npreston@health.usf.edu ▪ http://health.usf.edu/publichealth/academicaffairs/fe/
PRACTICE-BASED INTERNSHIP INSTRUCTIONS FOR STUDENTS
One semester before your internship
1. Meet with your major professor(s) and/or committee during the semester prior to placement to receive permission
to begin the process and to determine the type of placement of interest to you. Be prepared to discuss your
career goals, areas of interest, professional strengths and weaknesses, skills you wish to develop, preference for
organization or agency, geographical location, educational needs and review your resume/CV.
2. Develop learning goals in consultation with your major professor(s). Refer to Section II of the DrPH Student
Manual for specific guidelines.
3. Identify an internship site(s) in consultation with your major professor(s). Refer to Section II of the DrPH Student
Manual for specific guidelines. A list of previous sites for master’s level students can be viewed on the field
experience website.
4. Make a final site selection, contact the prospective preceptor and visit the internship site, if feasible. Initial contact
should include a cover letter requesting to complete an internship under their leadership along with a current
resume/CV. Be sure to identify projects that you would like to work on at that particular site in your cover letter.
5. Take your current resume/CV and writing/work samples to the preceptor interview. Use this time to determine the
scope of your internship and related activities available at the site. Explore overall goals and possible projects.
6. Develop learning objectives in consultation with your major professor(s) and preceptor. Review the Association of
Schools of Public Health Core Competencies for DrPH students and incorporate as many competencies into your
internship as possible. Refer to Section II of the DrPH Student Manual for specific guidelines.
7. With concrete learning objectives, the student and preceptor will identify specific tasks and deliverables to
evaluate the student. The objectives and deliverables comprise the internship plan, which must be approved by
the major professor(s) and committee. Refer to Section II of the DrPH Student Manual for specific guidelines.
8. Complete the Supervised Practice-Based Application, Agreements and Plan. Sign where appropriate and secure
signatures from your major professor(s) and preceptor.
9. Refer to Section II of the DrPH Student Manual for specific guidelines on the number of credit hours that are
required for your program.
10. Submit the completed and signed Supervised Practice-Based Application, Agreements and Plan forms to the field
experience manager. Secure copies for yourself, major professor(s) and preceptor in advance.
11. Complete the COPH Registration Worksheet (http://publichealth.usf.edu/forms.html) and Specialized Study
Contract (PHC 7908). They must be approved and signed by the major professor(s) and preceptor.
12. Submit the completed worksheet and contract to academic affairs. A permit for registration will be issued within
24 business hours.
13. Go to OASIS on the USF website to complete your registration. Because the internship has variable credit hours
(1-9), the number of hours you select in OASIS must match the number of hours for which you were approved.
During/after your internship
14. Mid-term and final evaluations are conducted in person with the major professor(s), preceptor and student. Refer
to Section II of the DrPH Student Manual for specific guidelines.
15. Copies of all reports, evaluations, etc. should be given to the field experience manager.
16. The student will give an oral presentation their committee and other faculty/students as deemed appropriate.
Refer to Section II of the DrPH Student Manual for specific guidelines.
2
PRACTICE-BASED INTERNSHIP APPLICATION AND AGREEMENT
Portions of this document must be TYPED in MS Word, printed for appropriate signatures and returned to the Field Experience
Manager before registering for Specialized Study.
Date:
Internship Credit Hours:
Name:
Student ID #:
Address:
Telephone: (
USF E-mail:
Term for Internship:
Dept:
CFH
GH
-
Fall
Spring
Summer 20
Major Professor(s):
(agency name) located in
(term) 20
)
(city, state) agrees to accept
semester. The student will earn
credit hour(s) by working for a minimum of
= 45 contact hours) contact hours. The field placement will begin on
under the direct agency supervision of
(student name) as an intern during the
and end on
.
(1 credit hour
The student will be
(preceptor) who will assist the student in carrying out assigned duties and
cooperate in evaluating the student’s performance. The supervisor asserts that the internship is not a part of the student’s
regular employment responsibilities.
__________________________
Student’s signature
__________________________
Major professor’s signature
__________________________
Major professor’s signature
__________________________
Preceptor’s signature
__________________________
FE Manager’s signature
___________
Date
Print Name
Telephone #
Print Name
Telephone #
Print Name
Telephone #
Print Name
Telephone #
___________
Date
___________
Date
___________
Date
___________
Date
Natalie D. Preston-Washington 813-974-7714
Print Name
Telephone #
3
SITE SELECTION CRITERIA
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An organization or agency that provides planning or services relevant to
public health
Enables the student to further develop and apply specific skills or
competencies learned in the academic program (e.g. advocacy,
communication, community/cultural orientation, critical analysis,
leadership, management, professionalism and ethics)
Provides a preceptor who is willing and able to spend regularly scheduled
time with the student and provide guidance. In addition, the preceptor
should consider herself/himself a public health practitioner
Afford the student regular/daily contact with public health practitioners
Exhibits a willingness to gradually increase student responsibility and
independence over the duration of the internship
Provides support including a dedicated workspace, desk, phone, access to
appropriate equipment
A good match with the needs of the student and academic concentration
Willing to consider a stipend, salary, lodging and/or transportation
DESIRABLE PRECEPTOR TRAITS
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Approachable and provides feedback
Interested in academic and career goals of student
Gives assignments that balance administrative work with substantive tasks
Monitors student activities through regular meetings
Helps student meet learning objectives as stated in the internship plan
Provides adequate resources and materials for student to be successful
Gives student advice about his or her career path
Tries to integrate student with the regular staff
Views student mistakes as learning opportunities
Introduces student to others who can help with his or her career
Gives student the chance to learn new skills
Allows student to take part in projects where he or she can be involved
from beginning to end
Provides student with a reference for his or her credential file or dossier
Provides expertise in area of student interest
ROLES AND RESPONSIBILITIES
Preceptor:
1.
2.
Aid student in developing the internship plan prior to the beginning of the placement
Review the Association of Schools of Public Health Core Competencies for DrPH students. Incorporate as many competencies into the internship as
possible, especially leadership
3. Provide work experiences that are academically challenging and worthy of graduate level credit
4. Explain the structure and function of the agency
5. Help student plan and execute specific projects/activities
6. Introduce the student to other affiliated colleagues and agencies
7. Invite student to professional meetings and encourage presentations at those meetings
8. Model professional work habits and attitudes
9. Record time student spends with the agency
10. Conduct midterm and final evaluations of the student
11. Refrain from discrimination on the basis of gender, race, color, age, national origin, religion, or disability
_______________________________________________
Preceptor’s signature
Date
University Representatives: (Major professor(s) and Field Placement Manager)
1.
2.
3.
4.
5.
6.
7.
8.
Contact agencies to cultivate placements for interns
Aid student in selecting an internship site, developing the learning objectives, deliverables—internship plan—prior to the beginning of the placement
Consult with agency concerning selection, experience and progress of students working at the agency
Visit student on site during presentations, when feasible, and collaborate with preceptor in making recommendations
Monitor the academic progress of the internship, provide timely feedback to student and preceptor and issue grade for the internship
Conduct midterm and final evaluations of the student
Keep individual student files for internship documentation
Conduct seminars for agency preceptors and students
__________________________________________
Major professor’s signature
Date
__________________________________________
Major professor’s signature
Date
____________________________________________________
FE Manager’s signature
Date
Student:
1.
2.
3.
4.
5.
6.
7.
8.
Contact agency to confirm the internship
Determine learning objectives and deliverables and submit via the internship plan
Adhere to agency regulations
Maintain professionalism, confidentiality and ethical standards
Keep a record of time spent at the agency or agency related activities. Keep a log of activities
Participate in professional and in-service activities at the site
Attend seminars at the College
Complete all required reports and assignments and share them with appropriate personnel
_______________________________________________
Student’s Signature
Date
4
PRACTICE-BASED INTERNSHIP AGREEMENT,
DISCLOSURE, AND CERTIFICATIONS
This is a release. Please read carefully and understand the details before signing.
Students must submit this completed form to the Field Placement Manager prior to registration.
I,
, am a student at the
USF College of Public Health and will undertake an internship during the
(select one)
Fall
Spring
Summer 20
(internship site) -
semester at the following location:
(city, state, country)
The University of South Florida Board of Trustees, a public body corporate through its College of Public
Health, does not control the way in which the work experience and the placement site is structured or
operates. In granting academic credit for this internship, the College affirms that, to the best of its
judgment, the experience is an appropriate curricular option for students in a DrPH program of study
and worthy of college credit. The college makes no other assurances, express or implied, about any
travel and/or living arrangements the student has made. The College of Public Health does not
knowingly approve internship opportunities that pose undue risks to their participants. However, any
internship or travel carries with it potential hazards which are beyond the control of the College and its
agents or employees, and I assume the responsibility of any and all such risk. By signing below, I
indicate that I have read this “Student Practice-Based Internship Agreement, Disclosure, and
Certifications” document and understand and agree to the following:
INSURANCE COVERAGE
I have sufficient health, accident, disability and hospitalization insurance to cover me during my
internship. I further understand that I am responsible for the costs of such insurance and for the
expenses not covered by this insurance. I recognize that neither the University of South Florida nor the
College of Public Health (“College”) have an obligation to provide me with such insurance coverage. I
understand that if I use my personal vehicle for the benefit of the organization/agency with whom I
perform my internship that USF/College have no liability for personal injury or property damage that
may result from that use. I agree to rely solely on my personal vehicle insurance coverage and on any
insurance coverage provided by my internship organization/agency.
PRECEPTOR RELATIONSHIP
I understand that the internship work experience is not an offer of employment. Rather the experience
is for educational purposes with a set termination date. I also understand that USF/College assume no
liability for personal injury that I may suffer in the course of my internship, and I agree to be responsible
for ascertaining whether the organization/agency sponsoring my internship provides workers
compensation coverage for me. I understand that the preceptor is not required to provide monetary
compensation for the time I spend at their place of business during the internship. I agree to be
responsible for ascertaining whether the preceptor will or will not provide monetary compensation.
USF/College prohibits discrimination on the basis of gender, race, color, age, national origin, religion,
or disability. USF/College requires the preceptor to affirm that he/she also prohibits any and all such
discrimination.
PERSONAL CONDUCT
I understand that the responsibilities and circumstances of an off-campus internship require a certain
standard of professional decorum that may differ from that of the College of Public Health, and I
indicate my willingness to understand and conform to professional standards of the internship site. I
further understand that it is important to the success of the present internship and the continuance of
future internships that I observe standards of conduct that would not compromise USF/College in the
eyes of the individuals and organizations with which it has dealings. I understand that I am responsible
for my own actions and conduct while at the internship site and any damage that I may cause is my
sole responsibility. I acknowledge the field placement manager’s responsibility for setting rules and
interpreting conduct for this purpose. I agree that should the college administration decide that I must
be terminated from my internship because of conduct that might bring the program into disrepute, or
the internship program into jeopardy, that decision will be final (subject to review by the Dean of the
College and/or the Academic Policies Committee) and may result in loss of academic credit for the
internship.
GENERAL RELEASE
I understand that USF/College reserve the right to make cancellations, changes or substitutions in
cases of emergency or changed conditions or in the general interest of the internship program. I
understand that the College’s field placement manager may take any action he/she considers to be
warranted under the circumstances and/or to guard the integrity of the internship program, including
termination of the internship experience.
I further expressly agree that the internship site and my use of any facilities shall be undertaken by me
at my sole risk and that USF/College shall not be liable for any and all claims, demands, injuries,
damages, actions, or causes of actions, whatsoever to me or to my property arising out of or connected
with the internship and with the use of any and all services or facilities associated with the internship,
whether or not sponsored by USF/College. I release, discharge, and covenant not to sue USF/College,
its governing board, employees, or agents as to any and all liability that may arise out of any injury or
harm to me, death, or property damage resulting from my participation in this internship, excepting only
liability due to the willful misconduct of the College.
I give the College permission to release my comments on the internship, the academic curriculum or
other related information for the purpose of improving or promoting the internship program.
I also warrant that I have disclosed all relevant, pertinent information in written form to the field
placement manager that could affect my ability to successfully complete the internship.
PRINT NAME:
STUDENT’S SIGNATURE:
_______________________________________________________________
DATE:
_______________________________________________________________
PRACTICE-BASED INTERNSHIP INFORMATION
Attach your preceptor’s business card to this form.
STUDENT INFORMATION:
NAME:
# OF CREDIT HOURS:
TERM FOR INTERNSHIP:
FALL
SPRING
SUMMER
20
DEPARTMENT:
PRECEPTOR(S):
STUDENT RESIDENCE:
CITY, STATE , ZIP:
RESIDENCE PHONE:
(
)
-
(
)
-
FAX: (
)
-
FAX: (
)
-
USF EMAIL ADDRESS:
DEGREES EARNED:
REGULAR EMPLOYER:
JOB TITLE:
CITY, STATE, ZIP:
WORK PHONE:
EXT.
DATE OF BIRTH:
GENDER:
ETHNICITY:
CAUCASIAN
BLACK/AFRICAN AMERICAN
ASIAN
MEXICAN AMERICAN
OTHER/UNDECLARED
MALE
FEMALE
HISPANIC/LATINO
PACIFIC ISLANDER/NATIVE HAWAII
AMERICAN INDIAN/ALASKA NATIVE
EMERGENCY CONTACT INFORMATION:
NAME:
RELATIONSHIP TO STUDENT:
CITY, STATE , ZIP:
RESIDENCE PHONE:
(
)
-
FAX: (
)
-
EMAIL ADDRESS:
INTERNSHIP SITE INFORMATION:
PRECEPTOR:
ACADEMIC CREDENTIALS:
USF COPH
STUDENT?
ALUMNUS? IF YES, GRAD YR/CONCENTRATION
AGENCY/ORGANIZATION:
DEPARTMENT/PROGRAM:
JOB TITLE:
ADDRESS:
CITY, STATE, ZIP:
PHONE:
(
EMAIL ADDRESS:
IS THE INTERNSHIP IN A RURAL
)
-
EXT.
IS THE INTERNSHIP PAID?
YES
NO OR LEADERSHIP
SERVE AN UNDERSERVED POPULATION
YES
NO ?
FAX: (
YES
YES
NO
NO SETTING?
)
-
PRACTICE-BASED INTERNSHIP PLAN
The student plan should be drafted on the following pages. If agreed upon by all, then the student, major professor(s)
and preceptor must sign the plan before presenting it to the student’s committee.
Internship Plan – Due with initial FE Application and Agreements
Refer to Section II of the DrPH Student Manual for specific guidelines on developing learning goals,
objectives and deliverables that will comprise the internship plan.
Students should review the Association of Schools of Public Health Core Competencies for DrPH students and
incorporate as many competencies into the internship as possible.
Students may also choose to include:
Timeline—State the expected dates for involvement in and completion of the activities. Provide a
temporal view of the entire lifetime of the project. Show when tasks will take place. This will be useful for
tracking your progress: How does the actual progress compare with the planned schedule? Your timeline
can graphically show how much of each task has been completed at a given time. Revisit the timeline as
the project progresses and compare the planned and actual schedules.
Other Considerations—Note any additional information that is necessary for defining your internship plan
or expectations, roles and relationships of parties involved, etc.
Organizational background:
*If your internship site is the same as your job, make sure that you clearly articulate how you are doing something
above and beyond your regular job responsibilities. Your internship should be a new, challenging experience. See
http://health.usf.edu/publichealth/academicaffairs/fe/dfe/faq.html#placeofemployment for more information.
Overall learning goal(s) for the internship:
1.
2.
3.
4.
5.
Learning Objective(s):
1.
2.
3.
4.
5.
Deliverables that relate to the Learning Objectives listed above:
1.
2.
3.
4.
5.
ASPH Core Competencies for DrPH students that your internship will address and what activities
you will engage in to gain experience with them and support your learning objectives):
1.
2.
3.
4.
5.
6.
7.
8.
Timeline for internship:
Other considerations:
__________________________
Student’s signature
__________________________
Preceptor’s signature
__________________________
Major professor’s signature
__________________________
Major professor’s signature
Continue on another page if needed.
___________
Date
Print Name
___________
Date
Print Name
___________
Date
Print Name
___________
Date
Print Name
PRACTICE-BASED INTERNSHIP EVALUATION
Formal mid and final evaluations are held in person, if practical, with the major professor, field supervisor,
and student. Those tasks or projects to be completed by the mid-point are reviewed along with progress
toward objectives. A record of the review is developed based on achievements and work completed as
well as documentation of tasks necessary to achieve for the final review; this record is signed by all
parties. Final reviews are conducted in the same manner. Evaluations are based on completion of all
tasks or projects, if the objectives were met, and achievement of the broad-based goals developed when
the internship was initiated.
Upon completion of the final Internship experience the student will be required to give an oral presentation
to the committee and invited faculty and students. A two-page summary of the oral presentation should be
submitted to the major professor(s) in advance. The presentation will include, but not be limited to:
1. Site description(s) and setting(s), location, supervisor’s role
2. Purpose of the internship within the context of the agency
3. Goals and outcomes
4. Lessons learned and experiences that can be helpful for other students
5. Competencies and relevancy to leadership and public health