Health Sciences Internships

Internship course intent form

The intent form must be submitted and approved before starting an internship for credit. Failure to do so could result in denial of your internship for credit experience.

Once permission has been granted for the internship, you can register for the course, HLSC-H 495.

Fields marked with * are required.

Complete the HLSC-H 495 intent form

Student Contact information
Student Name First Last
IU Email Address
Student ID *

Maximum of 10 characters allowed. Currently entered: 0 characters.
Campus IUPUI Fort Wayne
Cell Phone - Area Code - Prefix Line Number
Alternative Phone - Area Code - Prefix Line Number
On occasion, the department internship program is approached by the media, IUPUI Administrative Offices, or SHHS Marketing and Communications for interviews with current or past interns. Would you welcome these requests? (By checking yes, you are giving permission to share your contact information above with individuals from IUPUI or other media outlets.) Yes No
Internship information
Semester planning to take HLSC-H 495, e.g. Spring 2024 *
Duration of internship (start to end date) *
Employer/Company Name *
Employer Website
Intern Supervisor Name First Last
Supervisor Title *
Supervisor Phone - Area Code - Prefix Line Number
Supervisor Email
Type of internship Paid Unpaid
Description of internship duties

Maximum of 300 words allowed. Currently entered: 0 words.
Project idea and description

Maximum of 300 words allowed. Currently entered: 0 words.
List three objectives of your internship

The objectives are what you hope to achieve or learn during the internship, not the specific job duties you will perform. For example, if you want to learn more about the work experience of a physical therapist, your objective could read, “Observe and learn about the daily routine of a Physical Therapist.”
Objective 1 *
Objective 2 *
Objective 3 *
By typing your name below, you grant your instructor permission to contact your site supervisor to assess progress. You also grant permission for your instructor to share your progress within your academic department. *

Questions?

If you have a question about internships in the Department of Health Sciences, please contact Kathy Berlin at kberlin@iu.edu.

Health Sciences Internships

Internship course intent form

Complete the HLSC-H 495 intent form

Complete the HLSC-H 495 intent form

Student Contact information

Internship information

List three objectives of your internship

Questions?

School of Health & Human Sciences resources and social media channels