Host Sponsor/Preceptor Intake Form

To assist us in matching students with placements that fit their learning objectives, please provide a brief description of the educational experience your field placement offers. The information below will be placed on the Rush Education and Career Hub Database. The program staff and students use this source extensively to learn about your agency and field placement opportunities. You may update the description as needed.

Host Information

See example here: https://drive.google.com/file/d/1sV2OjIbLKMa07dvAQ-OXFsJWRW_lH0b9/view?usp=sharing

Are you a Rush facility or an outside organization?*
Is your organization or agency a clinical or non-clinical area?*
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Have you hosted an intern before?*

Job Description Questionnaire

Do you have a current student intern job description (HS/College)?*
Drag and drop files here or

In order to help us co-develop a student intern job description, please complete the following questions.

(e.g. department-specific LeapOnline training, transporting patients, etc.)

See Example Activities: https://docs.google.com/document/d/1ielFUAf1-6EZBnwabbUZgJzs-tke7HfGhY0G3-1gQKk/edit

Educational Approach

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Department Accommodations

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Are you interested in providing stipend support for your interns?*
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