Public Health 4960 Intern Application
Health Promotion and Education Center (HPEC)
Cal State L.A. Student Health Center
Application Deadline: To ensure full consideration, completed applications should be submitted one full
semester prior to internship semester of interest. Because we are not able to accommodate all applicants,
you are strongly encouraged to explore internship opportunities at other sites.
Instructions: Please complete this application form and submit it to: Stephanie Toledo, MPH, Health
Education Assistant, at stoledo3@calstatela.edu
Semester in which you would like to complete your internship with us:__________
Last Name
First Name
Phone Number
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Cal State L.A. Email Address (Note: Communication is via CSULA email only)
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1. Why are you interested in this position and what do you hope to gain from it?
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2. What personal resources and skills will you bring to our program that relate to the intern position?
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3. Please list jobs, previous intern work, training and/or any other experience you may have related to this position.
You can supplement this answer by attaching a resume.
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Cal State L.A. Student Health Center  Public Health 4960 Intern Application
4. Students seek the services of the HPEC regarding a variety of health issues. Please rank your comfort
level discussing the following issues. Rank them using (1) not comfortable at all or (2) comfortable.
Alcohol Choose an item.
Self-Esteem / Body Image Choose an item.
Contraception / Birth Control Choose an item.
Sexuality Choose an item.
Dating / Domestic Violence Choose an item.
Sexually Transmitted Infections Choose an item.
Depression Choose an item.
Stalking Choose an item.
Drug Abuse Choose an item.
Stress Choose an item.
Eating Disorders Choose an item.
Tobacco Use Choose an item.
Nutrition & Fitness Choose an item.
Weight Management Choose an item.
5. Please list the days and hours you are available to complete your PH 496 internship. (Note: Internship
hours are available only during HPEC service hours; Monday – Thursday, 8:30 a.m. – 4:30 p.m.)
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Monday: Click here to enter text.
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Tuesday: Click here to enter text.
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Wednesday: Click here to enter text.
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Thursday: Click here to enter text.
***See next page for internship program requirements***
Cal State L.A. Student Health Center  Public Health 4960 Intern Application and Program Requirements
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Cal State L.A. Student Health Center
Health Promotion and Education Center
PH 4960 Internship Program
Program Goal:
Offer Cal State L.A. students enrolled in PH 4960 with practical opportunities to apply learned core community health
education competencies in a university healthcare setting.
Program Objectives:
The Health Promotion and Education Center (HPEC) internship is designed to provide an experience that enables
students to:
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Apply program planning, implementation, and evaluation skills;
Contribute to HPEC and other Student Health Center programming;
Gain practical knowledge of key college health issues;
Provide appropriate health information and referrals to fellow Cal State L.A. students; and
Collaborate with Student Health Advisory Committee (SHAC) Executive Board by creating engaging outreach
activities for the student body.
Program Requirements:
Participation in the HPEC internship program is contingent upon students:
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Submitting the HPEC Intern Application no later than one full semester prior to internship semester of
interest;
Successfully completing the HPEC intern interview;
Being enrolled in PH 4960 during the semester in which internship activities are completed;
o Successfully completing the HPEC certified peer health educator training during specified dates
before the semester your internship starts.
Not later than the first week of internship, providing valid proof (or signed declinations/waivers) of:
o The following immunizations: hepatitis B, MMR, seasonal flu, and Tdap.
o A negative TB skin test or chest x-ray taken within 12 months of internship semester prior to the
completion of their first week of attendance.
NOTE: Interns are responsible for all costs associated with this requirement.
HPEC interns are expected to:
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Adhere to Cal State L.A. policies regarding student conduct;
Comply with Student Health Center policies and procedures which address patient confidentiality, employee
and facility safety, and infection control.
Complete required hours hours of approved internship activities over the course of the semester in which
the internship is completed;
Conduct a needs assessment; and plan, implement, and evaluate an intervention/ prevention workshop that
addresses a key college health issue;
Participate in HPEC events and other Student Health Center programming, as appropriate;
Act as a resource and provide client appropriate health information and referrals;
Cal State L.A. Student Health Center  Public Health 4960 Intern Application and Program Requirements
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Assist students seeking the services of the Health Promotion and Education Center;
Meet with HPEC health educators on an ongoing basis to discuss project goals, progress, etc.;
Collaborate with designated SHAC Executive Board members, to create, implement and evaluate Health Hut
themes education experiences and other activities;
Attend SHAC general membership meetings that occur every other Thursday 3:15 PM-4:10 PM, starting with
the first Thursday of the first week of classes;
Submit not later than week 12 of the internship semester a report detailing the intervention project; and
Complete an exit interview during the last week of the internship semester.
It is assumed that HPEC interns will: gain knowledge of college health issues; adhere to agreed upon schedules; meet
applicable deadlines; show initiative; produce quality work; and provide high quality customer service.
Cal State L.A. Student Health Center  Public Health 4960 Intern Application and Program Requirements
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