Fillable Prospective Internship Site Profile (University of Florida)

Fill Online, Printable, Fillable, Blank Prospective Internship Site Profile (University of Florida) Form

Use Fill to complete blank online UNIVERSITY OF FLORIDA pdf forms for free. Once completed you can sign your fillable form or send for signing. All forms are printable and downloadable.

Prospective Internship Site Profile (University of Florida)

On average this form takes 7 minutes to complete

The Prospective Internship Site Profile (University of Florida) form is 2 pages long and contains:

  • 0 signatures
  • 11 check-boxes
  • 22 other fields

Country of origin: US
File type: PDF

U.S.A. forms for University of Florida

BROWSE UNIVERSITY OF FLORIDA FORMS

Related forms
Fill has a huge library of thousands of forms all set up to be filled in easily and signed.
Fill in your chosen form
Sign the form using our drawing tool
Send to someone else to fill in and sign.
find another form
 
Prospective Internship Site Profile
Department of Health Education & Behavior
Location: ______________________________________________________ Date: __________________
City State
Agency: __________________________________________________________________________________
Contact: __________________________________________________________________________________
Address: __________________________________________________________________________________
Street / PO Box City State / Zip
Phone: ___________________________________ Fax: _____________________________________
Email: ___________________________________ Website: _________________________________
What semesters is your agency available to accept interns?
Fall (August – December) Spring (January – April) Summer (May – August)
Normal work hours (Please indicate any evening or weekend time commitments):
Is office space available to interns? Yes No ______________________________
Comments
Is a computer available to interns? Yes No ______________________________
Comments
Does your agency offer paid or non-paid internships? Non-paid Paid (amount): ___________
List other benefits your agency offers interns (i.e. housing, health insurance, travel reimbursement, etc.)
List required purchases for interning with your agency (i.e. parking pass, uniform, etc.)
Gainesville
FL
10/30/2020
LifeQuest Organ Recovery Services
Scott Mullen, MHA (Hospital Services Coordinator)
8491 NW 39th Ave
Gainesville
FL
352-733-0350
mullsc@lifequest.ufl.edu
https://lifequestfla.org
✔
✔
8:00 AM - 5:00 PM (can vary depending on project)
✔
✔
✔
N/A
N/A
List the required skills or previous experience necessary for interning with your agency.
Special Requirements (i.e. special application, proof of health insurance, immunization, etc.)
Please note: All interns are required to purchase professional liability coverage for $1,000,000.
Provide a comprehensive list of health education internship duties, which will be assigned to your HEB senior
intern. Please indicate with NCHEC Responsibility/Responsibilities align with each duty.
List any important information about your agency.
Would you like to be added to the Department’s list of approved sites for future interns? Yes No
FOR OFFICE USE ONLY:
Approval of Department Internship Coordinator: _________________________
Date
Contract on File: ________________________________________
Proficient in Microsoft Office
Immunizations, if interested in clinical ops (PPD Test, Hep B, Tetanus, MMR, Flu)
HIPPA Training
Ex: Plan and implement health promotion programs. (Responsibilities I, II, and III)
Surveying and planning for minority outreach for organ donation (Responsibilities I, II, III)
Develop communication strategies to increase awareness of organ donation during pandemic (II, V, VI)
Engage donor hospital key stakeholders to develop strategic plans to improve outcomes in organ donation
process (VII, IV, III)
Provide education to donor hospital staff relating to all phases of organ donation process (Hospital
Development, Clinical Operations, and Family Services) (V, VI, VII, VIII)
✔
Download
Save PDF to desktop
Email
Email completed PDF
Send for Signing
Email for others to sign
Print
Print document
Choose a Field
Click on a field and
select the person that should complete it
Want to add a signature?
You can add a signature field
and assign it to someone else
to sign
Choose a Field
Click on a field and
select the person that should complete it

Prospective Internship Site Profile (University of Florida)

This document is locked as it has been sent for signing.

You have successfully completed this document.

Other parties need to complete fields in the document. You will recieve an email notification when the document has been completed by all parties.

This document has been signed by all parties.

Completed 11 October 2021

Message

View Audit Log
Print With Audit Log
Duplicate Document