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Covenant Hospice - Internship Profile UWF revised2

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University of West Florida
Health Education Program
Prospective Internship Site Profile
1. Location: _______________________________ Date Completed: _____________________
City State
2. Agency: __________________________________________________________________________
3. Agency mission/purpose: ____________________________________________________________
___________________________________________________________________________________
4. Agency website (if applies): __________________________________________________________
5. Contact: __________________________________________________________________________
6. Address: _______________________________________________________
Street/P.O. Box Suite#
______________________________________________________
City State Zip
7. Phone: (______) _______-_____________ 8. Email Address:________________________________
9. ___Non-Paid ___Paid (amount) $_______________
10. Other benefits (i.e. housing, health insurance, travel reimbursement, etc.):______________________
____________________________________________________________________________________
____________________________________________________________________________________
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): ____________
____________________________________________________________________________________
____________________________________________________________________________________
___Very Flexible ___Somewhat Flexible ___Non-Flexible
Pensacola, FL
10/04/06
Covenant Hospice
We are dedicated to providing comprehensive, compassionate
service to patients and loved ones during times of life limiting illness
www.covenanthospice.org
Jo Graybeal
5041 North 12th Ave.
850
202
0914
jo.graybeal@covenanthospice.org
✔
none
✔
✔
unknown
✔
✔
✔
8-5 M-F
17. Required purchases (i.e. parking passes, uniform, etc.): ___________________________________
____________________________________________________________________________________
____________________________________________________________________________________
18. Required skills or previous experience needed: ___________________________________________
____________________________________________________________________________________
____________________________________________________________________________________
19. Description of intern duties (please include additional literature if desired): ____________________
____________________________________________________________________________________
____________________________________________________________________________________
____________________________________________________________________________________
____________________________________________________________________________________
____________________________________________________________________________________
20. Other important information about internship: __________________________________________
____________________________________________________________________________________
____________________________________________________________________________________
____________________________________________________________________________________
____________________________________________________________________________________
____________________________________________________________________________________
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
____________________________________________________________________________________
____________________________________________________________________________________
____________________________________________________________________________________
none
Working with people, flexible and adaptable,
interest in the hospice philosophy.
Uncertain at this
time. We are surveying the departments to see where there is a need. May do some rotation
withing different departments.
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Covenant Hospice - Internship Profile UWF revised2

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Completed 18 November 2019

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