University of West Florida
Health Education Program
Prospective Internship Site Profile
1. Location: _______________________________ Date Completed: _____________________
City State
2. Agency: __________________________________________________________________________
3. Agency mission/purpose: ____________________________________________________________
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4. Agency website (if applies): __________________________________________________________
5. Contact: __________________________________________________________________________
6. Address: _______________________________________________________
Street/P.O. Box Suite#
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City State Zip
7. Phone: (______) _______-_____________ 8. Email Address: ______________________________
9. ___Non-Paid ___Paid (amount) $_______________
10. Other benefits (i.e. housing, health insurance, travel reimbursement, etc.):______________________
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11. What type of interns does your agency seek? ___Part-time ___Full-time ___Both
12. What semesters is your agency available to accept intern placements?
___Fall (August to December) ___Spring (January to April) ___Summer (May to August)
13. Please indicate the last semester in which a UWF Health Education intern was placed with your
organization (if applies):_____________________________
14. Office space available to intern? ___Yes ___No
15. Computer available to intern? ___Yes ___No
16. Normal working hours (please indicate any evening or weekend time commitments): ____________
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___Very Flexible ___Somewhat Flexible ___Non-Flexible
Pensacola, FL
1/22/07
American Lung Association
Prevent lung disease; promote lung health
www.lungusa.org
Patsy Malley
4300 Bayou Blvd. Suite 2
Pensacola Florida 32503
478
5864
pmalley@lungfla.org
Spring 2007
8:30am - 4:30pm M-F (some weekends for events)
17. Required purchases (i.e. parking passes, uniform, etc.): ___________________________________
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18. Required skills or previous experience needed: ___________________________________________
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19. Description of intern duties (please include additional literature if desired): ____________________
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20. Other important information about internship: __________________________________________
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Please return to:
Melissa M. Howard, PhD, MPH, CHES
Assistant Professor, Health Education
Department of Health, Leisure and Exercise Science
11000 University Parkway
Pensacola, FL 32514
Phone: (850) 473-7110 Fax: (850) 474-2106
Department Comments
To be completed by Health Education Internship Coordinator
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NA
Computer-word, excel, publisher, powerpoint
-Public speaking, program presentations - media correspondence
- health fairs - support group coordination
- program development - office support
- patient assistance - power point creation
- event coordination - database management
- Flexible schedule
- Variety of learning opportunities