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RHS Internship Scheduling Sheet (Appendix A)

The RHS Internship Scheduling Sheet (PDF) requests that the following information be submitted to: 

RHS Academic Adviser
125 CEDAR Building
University Park PA, 16802 

Intern Information:

  1. Intern name, PSU ID number, PSU email address and personal email address
  2. Address and phone number where student will be living during internship (not site address)
  3. Permanent Address and Phone Number
  4. Semester Registering for Internship (RHS 495A)
Internship Site Information:
  1. Supervisor Name
  2. Agency/facility Name
  3. Agency/facility Address (including zip code)
  4. County located
  5. Population Served
  6. Site (Supervisor) Phone Number and email address
  7. Accreditation or Licensure (e.g. CARF, JCAH, PARF, M.A.)
  8. Is there a required written contract with the facility?
  9. Are you required to carry malpractice/liability insurance?
  10. Are you required to have a child abuse clearance?
  11. Are you required to have a memorandum of understanding?