Health Informatics Internship/Field Experience

University of North Texas

School of Library and Information Sciences

Internship/Field Experience Form

Stethoscope

"Diagnosing Your Information Needs"

Students:

  1. Fill out form. 

  2. Print using browser's Print button. 

  3. Click on Submit.

  4. Obtain signatures.

  5. Return signed form to faculty advisor. 

Student Name:
Student E-mail:
Student Phone:
Course Title:
Course Number:
Internship Site:
Site Supervisor:
Supervisor Phone:
Faculty Advisor:
Date Begin:
Date End (approx):

Objectives of Internship:
(Note: The objectives must be written with the advice and collaboration of the site supervisor and the Health Informatics faculty advisor.)

Internship Requirements:
Check the box to the left of the requirement to indicate acceptance of the requirement. If any modifications to the standard requirements have been agreed upon by the student, the site supervisor and the faculty advisor, enter those modifications in the Notes field.

Minimum of 180 hours Notes:
Log of activities Notes:
Project Notes:
Other (may be left unchecked) Notes:
Health Informatics Internship/Field Work Experience Form Notes:
Evaluation Form Notes:

Project Specifications:
Describe the project to be carried out at the internship/field work experience site:

Date Form Completed:
Student / Date Site Supervisor / Date Faculty Advisor / Date

This page was last modified on 08/22/2005 by Jodi Philbrick

Health Informatics Program
University of North Texas
School of Library and Information Sciences
P.O. Box 311068
Denton, TX 76203