Public Health 496 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 a
minimum of 2-3 quarters prior to internship quarter 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: Joanna Gaspar, MS, MPH, Senior
Health Educator, at jgaspar@calstatela.edu
Quarter in which you would like to complete your internship with us Choose an item.:
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 496 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 496 Intern Application and Program Requirements
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Cal State L.A. Student Health Center
Health Promotion and Education Center
PH 496 Internship Program
Program Goal:
Offer Cal State L.A. students enrolled in PH 496 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; and
Provide appropriate health information and referrals to fellow Cal State L.A. students.
Program Requirements:
Participation in the HPEC internship program is contingent upon students:
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Submitting the HPEC Intern Application no later than two quarters prior to internship quarter of interest;
Successfully completing the HPEC intern interview;
Being enrolled in PH 496 during the quarter in which internship activities are completed; and
Not later than the first week of internship, providing valid proof (or signed declinations/waivers) of the
following immunizations: hepatitis B, MMR, seasonal flu, and Tdap. Interns must also provide proof of a
negative TB skin test or chest x-ray taken within 12 months of internship quarter prior to the completion of
their first week of attendance. 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.
Conduct a needs assessment; and plan, implement, and evaluate an intervention 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;
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.;
Submit not later than week 10 of the internship quarter a report detailing the intervention project; and
Complete an exit interview during the last week of the internship quarter.
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 496 Intern Application and Program Requirements
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Tentative Internship Timeline:
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Application and interview
Acceptance into program
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Weeks 1 – 3: Program Requirements & Introduction to College Health Education
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Weeks 3 – 4: Needs assessment development and implementation
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Needs assessments are conducted through literature review; evaluation of data from such sources as
the American College Health Association and the Centers for Disease Control and Prevention.
Weeks 5 – 8: Data analysis; Intervention development, implementation and evaluation; Write report
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Initial intern activities are focused on completion of “housekeeping” requirements such as TB
screening, completion of SHC confidentiality and other forms, and FERPA and HIPAA training.
Orientation to Student Health Center services.
Training on the following issues as they relate to collegiate health education - through online
tutorials, readings and presentations:
 Health education theory
 Sexual health
 Alcohol and other drugs
 Sleep
 Mental health disorders
 Stress management
 Relationships
 Weight management
 Relationship violence
During this phase of the internship, interns will collaborate with HPEC health educators and: analyze
collected data; create and implement a need appropriate intervention; and evaluate the
effectiveness of the intervention.
The intervention report will include such details as: needs assessment results; strengths and
weaknesses of the assessment tool and implementation strategy; intervention justification;
intervention evaluation; implications for future HPEC programming.
Weeks 9 – 10: Submit final report; Complete exit interview
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The intervention report is submitted not later than the beginning of week 10 to allow HPEC health
educators to provide constructive feedback and allow time for modifications, as appropriate.
During the exit interview interns provide the HPEC health educators with an evaluation of their
internship experience in relation to the goals and expectations of the Department of Public Health,
Student Health Center, and the intern.
Cal State L.A. Student Health Center  Public Health 496 Intern Application and Program Requirements
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