HCA 485





Internship Coordinator:                        

Tristen Amador                                                                           


It is your responsibility to contact the Practicum Site Coordinator prior to the semester in which you plan to begin your practicum. You must inform both the Practicum Site Coordinator and the HSA office 303-458-4157 a minimum of one month prior to your anticipated start date.


In order to ensure that you have appropriate liability and worker's compensation coverages throughout your placement, you must schedule your start date in accordance with the established University academic periods. Other than this restriction, practicum placements may end at any time and may continue across terms.


You must register before the last day of Add/Drop for the session in which you will begin, even if you are not starting until late in the session. Late registration will result in a late registration fee which we will not waive.


 Thank you for your cooperation.

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at a


To order the name tag, complete this form and send it to the department at the address below, along with a check for $8.50  +  ($2.50 postage if mailed).  Make check payable to Regis University.

 Send this completed form to: 

Regis University
            3333 Regis Blvd.
            Mail Code G-10
            Denver, CO  80221.

 Name of Student___________________________________________________

            Check one:

____ HCA Student

____ HIM student

 (Your name tag should be ready in 7 to 14 days.)

 When the name tag is ready (please check one):

             ___ Call me and I will pick the name tag up

                        Phone number:  _______________________

                         - or –

             ___ Mail the name tag to me at :  ________________________________


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The mission of the Health Care Administration Program is to create and maintain an atmosphere of learning excellence while preparing men and women for leadership in the community.

The internship is an important aspect of the student’s program as it is a means whereby classroom knowledge and practical experience come together to provide a unique learning experience.

To the Student, we at Regis hope your internship will be a memorable and valuable experience.

To the Site Supervisor, we are grateful for your cooperation and your commitment and assistance in the educational process of our students.

The information contained in the following pages is designed to help answer any questions you may have and to provide direction to both the student and the supervisor.

Please do not hesitate to contact the Health Services Administration and Management office (303-458-4157) if you need further assistance.

Sheila Carlon 
Program Director

Janet Houser
Program Faculty    






            Course syllabus and activities

            Objectives of Internship

            Criteria for Selection of Site 

            Student Attire for Internships & Practicums

            HCA Policies on Student Internship

            Cancellations and Rescheduling  

Resolution of Problems/Dismissals

Insurance Coverage

Definition of Terms

Clinical Coordinator Responsibilities         

Contact with Clinical Coordinator

Clinical Site Supervisor Responsibilities

Student Responsibilities       


Clinical Site Request Form  

Confidentiality Agreement Form


            Activities for the Administrative Internship

            Notebook  Preparation

            Project Report

            Administrative Internship Site Profile 


             Instructions for Work Experience/Education Summary or Resume

            Weekly Log form

Format of Weekly Summary Report

Student Evaluation of Internship


            Activities for the Administrative Internship

Guidelines for Student Orientation to the Clinical Site 

Student Performance Evaluation

Management Experience Assessment form 

Leadership/Management Styles





Tristen Amador, PhD, HSA Faculty (Colorado students)
458-4146 (work)

Hilda Delgado (Students outside of Colorado)

CREDIT HOURS:       Three credit  hours


This internship provides the healthcare administration student an opportunity to observe and participate in management activities in a healthcare setting.  Emphasis is on the ability to complete assigned management projects, gain an overview of the facility and its departments and participate in a wide range of functions including budgeting, human resource management, project management and quality improvement activities.

 PREREQUISITES:  Students should have completed all professional coursework in the Health Care Administration curriculum.  The internship may be taken concurrently with the Capstone course.

SUGGESTED TEXT:  No text required, but texts prior HCA classes may be helpful.


 Upon completion of the internship, the student should be able to:

  1. Frame and manage a project from its inception to implementation.

  2. Prepare statistical or budget reports using raw or aggregate data.

  3. Evaluate policies and procedures using institutional guidelines and make revisions appropriate.

  4. Critically evaluate a procedure or process and apply appropriate QI techniques to recommend changes.

  5. Identify managerial and leadership styles within an organization.

  6. Identify and describe supervisor and employee responsibilities.





The overall objective of the internship is to provide students with hands on, reality based experiences in a healthcare facility or related site, that will reinforce and enhance classroom learning. Experience in non-traditional sites is also encouraged as skills needed in the healthcare field expand into other industries.

While student preference is taken into account, the primary concern of the faculty is to provide the student with well-rounded clinical experiences and exposure to a variety of management styles and organizational practice.


The following are to be considered before the final selection of a site:

  1. Facility for the internship offers exposure to management, leadership and organizational functions.

  2. Facility is able to provide adequate clinical supervision.

  3. Clinical site agrees to and is able to meet facility responsibility as specified in the contract.

  4. Clinical supervisor agrees to supervise the student and act as mentor for completion of student project.


As health care professionals, students in degree programs in Health Services Administration are expected to dress in a manner that demonstrates professionalism during class, during on campus activities and in internship situations. While classroom attire can be of a more casual nature, internship and practicum dress should reflect professional taste and remain in line with the facility where the internship is scheduled.

Hair: Hair should be clean and neatly groomed.

Nails: Nails must be neatly manicured (not chipped) and kept at a length that will not interfere with any job duties you may be asked to perform. Some hospitals or agencies may have policies about acrylic nails, etc. which we will try to identify prior to placement.

General Hygiene: Offensive body odor and poor personal hygiene is not acceptable.

Jewelry: Take a conservative approach to wearing jewelry of any kind. Some facilities prohibit the wearing of jewelry for religious reasons. (Adventist hospitals, for instance). We will try to identify these prior to placement.

Shirts: Revealing clothing (e.g., tank tops, spaghetti straps, halter tops, midriffs, tube tops, swim tops) is not permitted, and proper undergarments shall be worn. Torso exposure will not be permitted. Men’s shirts must have sleeves and a collar. Shirts with graphics or print that may be considered distracting, provocative, or offensive are not to be worn on campus or at internship sites.

Skirts/Dresses: Skirt lengths must be of a conservative nature; no mini-skirts or tight fitting skirts are allowed. Skirts or dresses made of denim material are sometimes not permitted in facilities.

Pants/Slacks: Pants should fit properly around the waist, have no holes and should not be made of denim.

Shoes: Shoes must be clean and in good condition. Open toe shoes are permitted, but no flip-flops. The facility may dictate other rules for shoes. Again, we will try to identify this ahead of placements.

Head Gear: Only headgear worn for bona fide religious or medical purposes is permissible at internship sites.

A faculty member or internship placement coordinator who sees a student in violation of the student dress code policy will either address the student or notify the appropriate clinical contact. Continued infractions of the dress code policy will result in a discussion with the HSA Program Director and may place the student in Academic Jeopardy regarding professional behavior.


In order for the students to obtain the appropriate management experience, they are not to be substituted for paid staff.  Students may not take the responsibility or the place of "qualified" staff.  However, after demonstrating proficiency, students may be permitted to perform procedures with careful supervision.

  1. Exposure of the student to a variety of settings is a goal of the HCA program; therefore, it is strongly recommended that a student not be placed at a clinical site if they are employed by that facility.  However, due to travel constraints including work and personal responsibilities, exceptions may be granted by the Internship coordinator.  A clear understanding must be established with the student and Clinical Site Supervisor to avoid conflict of interest issues and to delineate content of clinical experiences.
  2.  Students should receive no remuneration for their internship activities.

  3.  Research and library time for project completion may be included in total hours.

  4.  Prior learning. Students with extensive management experience in health care may qualify for a reduction in the number of clinical hours. In order to exercise this option, the student must submit a request in writing to the HCA Internship Coordinator four (4) weeks prior to registering for HCA 485. The Clinical Coordinator and the Program Director will evaluate the request and notify the student of approval or disapproval within three weeks of receipt of the request. The request must include the following: 

The Clinical Coordinator and Program Director reserve the right to verify any and all documents submitted by the student.  If the request is approved, the student will receive a waiver of 20 hours towards the completion of the total internship and must complete the remaining 100 hours at the site or working on the project assigned. Students will be charged the full cost of the course for evaluation of the prior learning option.


Once the internship dates have been approved and confirmed, no cancellations or rescheduling will be done except under extenuating circumstances such as illnesses, death in the family, unexpected staffing problems at student’s job site, or request of the clinical site.

A student should not cancel an internship without such extenuating circumstances since rescheduling is time consuming and an appropriate substitute clinical site may not be readily available.


Should any problem arise during the internship, the Clinical Coordinator will make every effort to solve the difficulty with the student and Clinical Site Supervisor.  If it is not possible to amend the situation, the student will be removed from the clinical site and reassigned.

If, in the opinion of the Clinical Coordinator, the student is not being properly utilized by the clinical site (i.e., the student is being substituted for a paid employee or is assigned only clerical tasks (filing, telephone answering, typing), the Clinical Coordinator will discuss this concern with the Clinical Site Supervisor in an attempt to resolve such a situation.  Again, if this situation cannot be resolved to the satisfaction of the Clinical Coordinator, the student will be reassigned.

Student behavior detrimental to the morale and conduct of business within the internship will be grounds for removing the student from the affiliation and from the program.  Such conduct as ignoring or overriding the requests of the Clinical Site Supervisor or designated representative, failure to meet requirements of the facility regarding dress and conduct will also be grounds for removal.

If the student's conduct is unethical (improper release of confidential information) or unprofessional (disparaging remarks) the student will be dismissed from the program.  Carelessness in dress and lateness will place the student on probation.  Failure to redress these problems will lead to immediate dismissal from the program.


A list of all potential internship students, dates of rotations, and sites will be sent to the Business Office so that the students will be covered by Regis University Worker's Compensation during the internship periods.  All internship students are expected to carry personal health and liability insurance coverage.


  1. Clinical Site Supervisor - Individual employed by a clinical facility, who accepts responsibility for overseeing and directing the student’s activities during the clinical experience. This person is usually an administrator, supervisor or manager of the area at the site. 

  2. Clinical Coordinator - Individual employed as faculty by Regis University and is the designated coordinator of internships for Healthcare Administration students. The Clinical Coordinator contacts clinical sites, makes arrangements for clinical placement, evaluates the student’s reports and assigns the final grade based on the clinical site supervisor’s evaluation, the quality of the report and observations of the coordinator during the student’s clinical experience.    



  1. The Cllinical Coordinator contacts the site selected by the student and reviews the policies and procedures with the designated site supervisor.
  2. The Clinical Coordinator conducts an assessment of any new site and initiates the contract process as needed.
  3. Upon mutual agreement of times, dates and student assignment, the Clinical  Coordinator sends confirmation letters to all parties to include: 
    a.         Clinical Site Supervisor
    b.         HCA Student
    c.         HSA Program Director

  4. The Clinical Coordinator provides all parties with phone numbers to facilitate communication between the site and the HCA student.
  5. The Clinical Coordinator monitors each student's performance by making weekly contact by phone and/or an on site visit to the facility.
  6. The Clinical Coordinator reviews weekly logs and summaries submitted by the students and provides timely feedback and advisement as necessary.

  7. If there are reports of poor performance or incompatibility, the Clinical Coordinator intervenes immediately to assess the situation and make changes as necessary to accommodate the needs of the student and clinical site.

  8. Upon conclusion of the Internship, the Clinical Coordinator will submit individual student grades based on summaries, projects, final papers, notebooks, and grade recommendations provided by the Clinical Site Supervisor.

  9. The Clinical Coordinator immediately refers any matters of an unusual nature to the attention of the Health Services Administration & Management Program Director.


The Clinical Coordinator may arrange for a site visit during the student's internship.  In addition, the Clinical Coordinator will contact each student weekly.

The Clinical Coordinator will discuss the student's progress, using the weekly summary as a guide.  Suggestions and questions on these reports plus a general discussion on the student's overall experiences will be the subject of these contacts.


    1. The Clinical Site Supervisor provides the Regis Health Services Administration and Management Program with an updated Curriculum Vitae/Resume.
    2. Whenever possible, the Clinical Site Supervisor meets with the student prior to the Internship start date to discuss the Internship in general and the scheduling of activities.
    3. The Clinical Site Supervisor provides Regis Coordinator and the student with a weekly schedule so that the student, the program, and the supervisor can be assured that the student will receive a thorough overview of site’s activities. It is also recommended that the Supervisor or Designee meet periodically with the student to discuss progress, assignments and status of the project they are working on.
    4. All HCA students have signed a Confidentiality Statement which is kept on file in the Clinical Coordinator’s office. A copy of the statement signed by the student can be sent to the site upon request.
    5. The Clinical Site Supervisor brings any questions or concerns that arise during the Internship to the attention of the Clinical Coordinator and/or Program Director as soon as possible.
    6. The student evaluation is completed and sent to the Clinical Coordinator within two weeks after the completion of the Internship. It is highly recommended that the evaluation be reviewed with the student since input from each Clinical Site Supervisor is an essential part of the evaluation process.
    7. In assignment of a grade, the Clinical Site Supervisor applies standards that are comparable to those of the academic environment. Questions regarding assignment of a grade are referred to the Clinical Coordinator.
    8. The Clinical Site Supervisor may request a copy of the student's evaluation of the site by checking the appropriate box on the student evaluation.


  1. Complete the appropriate course registration.
  2. Submit a clinical site request form and a signed confidentiality statement to the Clinical  Coordinator .  Sample forms are included in this section.
  3. Provide proof of personal health insurance coverage and submit proof of immunizations.
  4. Obtain professional liability insurance coverage. (This is billed to each student upon registration in each clinical course and is provided under a blanket policy.)

  5. Contact the Clinical Site Supervisor, by phone or letter, prior to the beginning of the Internship to determine work hours.

  6. Complete an Education/Experience Summary with a copy to the Coordinator for HCA Internship. The format and instructions for the Education/Experience Summary are included in this section.  An up-to-date resume may be substituted.

  7. Maintain and submit a weekly log and summary.  (See sample format included.)  
  8. Complete a Site Profile.  (A sample form is included in this manual).
  9. Complete and submit the Student Evaluation of the Internship Site and notebook within two weeks following completion of the Internship.  (Instructions are included.)
  10. Notify the Clinical Site Coordinator, Clinical Coordinator or the Health Services Administration and Management Program Director of any problems, concerns or extenuating circumstances as soon as possible during the Internship.

Remember:  To a great extent, the student's own attitudes and conduct determine the success of the Internship.  As with every job, there are certain inconveniences or repetitious tasks involved in Internship.  A mature outlook, sense of humor, and willingness to "pitch in" will get you over the rough spots.




A 4.00 93-100 Outstanding scholarship
A- 3.67 90-92
B+ 3.33 88-89 Superior work
B 3.00 83-87
B- 2.67 80-82
C+ 2.33 78-79 Satisfactory work
C 2.00 73-77
C- .67 70-72
D+ 1.33 68-69 Unsatisfactory work of lowest passing quality
D 1.00 63-67
D- 0.67 60-62
F 0.00 Below 60 Failure (No credit)
I/F Incomplete.  The F will become permanent if work is not completed by the end of the following semester.  A written request and consultation with instructor is required.

 Final determination of a student's grade will be the responsibility of the Clinical Coordinator.  However, the Clinical Site Supervisor will be asked to recommend a letter grade for the student based on his/her performance at the clinical site. Grades are based on the following criteria:

Clarity, conciseness, completeness, and timeliness of weekly summaries and final report. 25%
Clinical Site Supervisor's assessment and written evaluation of a student's performance. 20%
Preparation and organization of a professional notebook outlining schedules, projects, flow charts, sample forms, etc. pertinent to the clinical experience. 25%
Student's demonstration of competence through the completion of projects and reports for the Clinical Site Supervisor. 30%

The Administrative Internships are an opportunity to showcase your skills and abilities to members of the profession.  Make the most of it!

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Date: ________________    Option: ___________________________________(six/three)

Student:_________________________ Address:_________________________  

PHONE:         W:_________________________


 I would like to request placement at the following sites listed by order of preference.




CITY/ST _________________________________________________________________

CONTACT _________________________________________________________________



CITY/ST _________________________________________________________________

CONTACT _________________________________________________________________



CITY/ST _________________________________________________________________

CONTACT _________________________________________________________________

TIME FRAMES FOR COMPLETION OF CLINICAL EXPERIENCE: Please provide specific dates and times that would work best with your schedule.



______            3 consecutive weeks at 40 hours per week

______            _____hours/week for _____weeks

______            20 hours per week (half days) for six weeks

______             Half days:        _____ 8:00 AM - 12N  _____ 1:00 - 5:00 PM

______             Other

 SPECIAL NOTE: A student will not automatically obtain placement at their requested site.  Placement is based on: 1) availability of the site 2) student/site compatibility 3) student's ability to relocate or commute to the site. 


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 C O N F I D E N T I A L I T Y   A G R E E M E N T

  Students in the Regis University Health Services Administration and Management Program may be working with health records of actual patients in various types of health care facilities and in the classroom and may be exposed in other ways to confidential information about patients or clients.

 Two factors must be considered that are relative to student use of health or business records in the educational process:

  1. Legally, the information in the health record belongs to the patient.  Any violation of confidential information about a patient found in the health or business record is punishable in a court of law.
  2. The institution where you complete your Internship will have policies in place that address confidentiality of their patients/clients and their health or business records. You may be required to sign additional confidentiality statements.

 Because of these legal and ethical considerations, any student enrolled in the Health Services Administration and Management Program who reveals contents of any record inappropriately, except as it relates to the educational process in the classroom or at the clinical site, may subject to immediate expulsion from the internship site and, as a result, may be expelled from the Healthcare Administration Program. 

Having understood the above I, _________________________________, do hereby agree to maintain the confidentiality of all patient information to which I am exposed as a student in the Health Services Administration and Management Program.

_________________      _____________________________________________
Date                                 Student Signature

                Witness/Program Director/Clinical Coordinator

Copies to: Student file
Clinical Site Supervisors

Note:  This must be completed and returned to the Clinical Coordinator along with the Clinical Site Request Form.

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The major focus of the Administrative Internship is for you to experience management in a health care or non-traditional setting, including the necessary interactions with other levels of administration. You will be assigned to work primarily with supervisors/managers within the department, becoming an extension of them.

While you may rotate through a department or area, the emphasis will shift from technical to managerial competencies such as problem-solving, employee relations, and administrative projects.  It is required that the student complete one or more projects that would allow practice in administrative decision making.  Ideally your project would involve:

  1. Stating the problem

  2. Reviewing literature

  3. Investigating the problem

  4. Finding alternative solution

  5. Selecting a solution and justifying the selection

  6. Setting a time frame for implementation or pilot study

  7. Indicating what the re-evaluation or monitoring process should be

  8. Identifying financial constraints or costs for the solution

  9. Suggesting further areas of study

Listed below are some possible projects you could choose to do or that might be suggested by the Site Supervisor.  This list is not exhaustive and projects unique to the facility, mandated by changes in professional practice or student choice can be substituted or added.


NOTEBOOK PREPARATION - due two weeks following internship

Your completed notebook (three-ring binder) should include at least the following:

  1. Copies of the weekly summaries.

  2. Documents and forms used during the management experience. (Appendices may be appropriate for such items)

  3. Separate sections for the Management Site Profile and additional questions.

  4. Completed Management Experience Assessment Form (See syllabus page 34)

  5. Completed Student Evaluations and Supervisor’s evaluations.

  6. Management Project.  (May be in separate notebook if necessary.)

  7. Tab all sections as well as miscellaneous items or appendices.

 This paper should be at least eight to ten pages in length and should summarize the project completed during the Internship.  It should provide an overview of the project, (a literature review if completed), a summary of  your approach and the outcome or applicability of your project to the workplace.  You should also include any recommendations, observations and/or opportunities for further study. (See recommended test on Project Management for additional information to include in report.)

You should also include with your report copies of report materials given to the site supervisor.  This will provide assistance in assigning your grade for the Internship.

This project report can be included in the overall Internship Notebook if possible.  If not, submit it in a separate notebook with appropriate tabs and appendices.

You should review your Project Notebook with your Site Supervisor prior to submission to the Clinical Coordinator.

You should produce three copies of your final report.  Turn in one to the Clinical Site Supervisor, one to the Internship Coordinator, and keep one copy for yourself.

This project comprises 30% of your total grade for the Internship.


The following profile and general questions should be contained within the body of your notebook and should be tabbed as “Site Profile.”

Name of Facility:________________________________________________________________________
Address:____________________________________________  Phone Number:____________________



Type of Facility/Agency ____________________________________________________________
            If Multi-hospital, number of other facilities:______________________________________________

            Chief Executive Officer:____________________________________________________________
            If hospital:  Number of Beds: Adult/Children:___________ Newborn:_____________
            Annual discharges:

                    Adult/Children:_________________ Newborn:_______________

            Annual ambulatory care patients:

                    Emergency:___________     Outpatients:_____________
                    Day Surgery:__________     Observation:____________

Other Client/Patient measures: __________________________

            Approved Internship/Residency Programs:_____________________________________________
            Trauma Center?_________________________  Emergency Dept._________________________
            Other specialty services:___________________________________________________________

Other facility:

             Describe the purpose, organizational structure, and other descriptors below:


  1.  What kinds of information, if any, does this department/organization provide?  To whom? 


  1. What is the purpose of the information?


  1. What types of systems are used to gather the information?


  1. Describe the budgeting process of the department.  Include who has major responsibility for it and how departments or individuals make requests for major or minor equipment, etc.



  1. What is the mission of the organization?


  1. What are the goals of the organization?


  1. Are there separate goals in the department you are in?  If so, what are they?  How do these goals relate to the mission of the organization?



  1. ow many FTE's are in the department/area you are assigned?



9.     Please provide an organizational chart of the department if available.

  1. What regulatory agencies does this organization deal with?  Are there licensing and accreditation affiliations?

11.  Review the organization’s (or department/area) policy and procedure manual.  Is it up-to-date?  How often are they revised?  Are there any unusual policies or procedures?  Select one that needs revision and with input from appropriate individuals, complete the revision process.  Include in your notebook.

12.  Are there any “Quality Initiatives” in progress?  If so, describe them.  If not, what suggestions could you make for an initial starting point?

13.  Does the organization adhere to any “school of thought” for quality?  (i.e. Deming,Juran, Crosby, etc.) or use a particular quality model such as LEAN, PDCA, Six Sigma, etc ?

14.  Select a process and draw a work flow diagram to illustrate the steps in the process.  (You can suggest improvements to this process.)

15.  Is there Union activity or are there active unions at this facility?  If so, describe your observations of its effect on management activities.

 Include any other pertinent information.

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by the



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 Prepare a summary of your work experience and education background using the following guidelines:

  1.  Typed or word processed
  2. White or beige bond paper
    Standard 8 1/2 x 11 sheets
  3. Use standard margins
    Follow format instructions provided below



PHONE        Work:                         Home:


  1. Use date of graduation from high school or college, but not both.  If you earned a degree, state type and area of study (i.e. BA English).
  2. State current school, beginning date, and anticipated date of graduation.
  3. State pertinent classes that have been completed to date and any courses currently in progress that may relate specifically to the area or facility you are requesting.


  1. Give current employer and date of employment plus a brief statement of job responsibilities.
  2. Give previous employer(s) with dates and statement of job responsibilities.

For those with minimal work experience or experience that is several years past, list unpaid employment (family business), volunteer work, etc.  List it exactly as that for paid employment.

 Keep summary to THREE pages!!  A current resume may be used in lieu of the summary.

Note: This form must be completed and sent in with the Clinical Site Request Form.

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Student Name:_______________________________________________Week of:______________________

Facility Name:____________________________________________________________________________ _


Date                                                    Clinical Activities                                             Hours Spent











                                                                            TOTAL HOURS ___________________


Signature of Clinical Site Supervisor or designated representative

IMPORTANT NOTE: The student must complete 120 clock hours of clinical experience per internship. All hours must be documented! FAX to: 303-964-5430

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  1. The weekly summary is due no later than the Thursday following the previous week completed.  This will give the Clinical Coordinator time to review your report and list any comments or questions to be discussed. (Example: Begin internship Monday, March 2.  First summary due Thursday, March 12.)

  2. All summaries must be typed, but the weekly log may be handwritten. The weekly log and summary should be stapled together.  (Keep a copy for your files!) Submit the weekly summaries directly to the Clinical Coordinator. (FAX to 303-964-5430)

  3. Please put your name, name of the site, dates covered, and type of internship on each page in the event the weekly log and summary become separated.

  4. The weekly summary expands on your weekly log.  It should give a detailed summary of all activities completed, areas covered, employees worked with, and any comments about the overall work flow, morale, and supervision within the department.

  5. The summary does not need to be detailed. Generally 2-3 typed pages should be sufficient unless the week was particularly full of activities.  Conversely, you may have a week where you primarily worked on one activity and as a result your summary will be shorter.

  6.  Please sign your name at the end of the summary.

  7.  Please feel free to discuss your weekly activities with the Clinical Coordinator.  You may be asked to clarify or expand upon some aspect of your summary.

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Student Name:_______________________________________            Dates:_________________________


Site Supervisor:__________________________________________________________________________

  1.  Describe the process in which you received a general orientation to the facility.
  1. Did you receive a tour of the department or your assigned area and were you introduced to departmental and other staff employees?
  1. Was your schedule of activities available to you on your first day, and did you generally adhere to this schedule?   
  1. List some examples of your ability to communicate, verbally or in writing, with your Clinical Site Supervisor (meetings, memos, reports, etc.).   
  1. Was assistance generally available when you needed it? (For example, when you had questions about procedures, etc., was someone available?)  Did you feel you were adequately supervised, given your level of experience?
  1. Were you given some exposure to other departments and professionals?  How?   
  1. Did you have sufficient time to meet with your Clinical Site Supervisor or designee?  
  1. Give some examples of how you were involved in activities of the department or the area to which you were assigned.  
  1. What aspects of this internship did you enjoy most?   
  1. What aspects of your course work were most clarified through this internship?  
  1. In general, did you feel classroom learning prepared you for this experience, or were there areas that needed additional class time?
  1. What aspects of this internship did you find least relevant to your learning experience?  
  1. Please list what you feel were the weak points of this site, and list some suggestions for improving future internships.
  1. Please list what you feel were the strengths of this site, and whether you would recommend continued use of the facility as a internship site.



             4                   3                         2                            1

Excellent          Very Good         Satisfactory         Below expectations

Additional comments: _____________________________________________________________________


Signature of Clinical Site Supervisor or designated representative

   * * * * * * * * * * * * * * * * * * * * *


for the


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The major focus of the Management Internship is for the student to experience management in a health care or non-traditional setting, including the necessary interactions with other levels of administration. The student should be assigned to work primarily with supervisors/managers within the department, becoming an extension of them.

While the student may rotate through a department or area, the emphasis will shift from technical to managerial competencies such as problem-solving, employee relations, and administrative projects.  It is required that the student complete one or more projects that would allow practice in administrative decision making.  Ideally the project would involve:

  1. Stating the problem

  2. Reviewing literature

  3. Investigating the problem

  4. Finding alternative solutions

  5. Selecting a solution and justifying the selection

  6. Setting a time frame for implementation or pilot study

  7. Indicating what the re-evaluation or monitoring process should be

  8. Suggesting further areas of study

Listed below are some possible projects that have been done in the past. This list is not exhaustive and projects unique to the facility, mandated by changes in professional practice or student choice can be substituted or added.


*The site supervisor should review the project prior to the student’s departure from the site.

  ~~ Page Break ~~


The following guidelines are intended to assist you in preparation for your student.  We believe these guidelines will help to prevent confusion, improve communication, and set the tone for a smooth clinical experience.


  1. Student's schedule of activities**

  2. Written description of any projects you want the student to complete**

  3. Information regarding presentations you want the student to plan**

  4. Organizational charts of the department and facility

  5. Departmental/institutional policies and procedures

  6. Other items you feel will assist the student in adjusting to and understanding your facility.


  1.  Brief tour of the facility

  2. Tour and introduction to related departments and areas where student will have contact.  Suggested departments include:

    ·        Admissions/Registration 

    ·         Employee Relations

    ·         Business/Billing Office         

    ·         Ancillary Services

    ·         Quality Assurance                

    ·         Human Resource Management

    ·         Risk Management                       

    ·         Management Information Systems

    ·         Utilization Review                       

    ·         Medical Staff Office

  3. Detailed tour of the Department or area where the student will be assigned and introductions to employees and supervisors.


  1.  Beginning and ending time of work day
  2.  Person to whom student will report
  3.  Contact person when the Clinical Site Supervisor is unavailable
  4.  Your expectations of the student
  5.  Student's expectations of you and the internship experience
  6.  Meals and breaks
  7.  Location of rest rooms, cafeteria, lockers, etc.
  8.  Nearest emergency exit;  fire and disaster procedures; security, access to systems
  9.  Infection control and hazardous materials policies
  10. Dress code of your facility


  1. Necessary identification
  2. Parking
  3. Attending employee orientation
  4. Meal passes
  5. Other specific facility requirements

 **A detailed schedule of activities is recommended.  A schedule which includes daily activities completing their tasks.  Likewise, if you are able to provide written instructions for any project or presentation you would like the student to complete, he or she will be able to spend unassigned time more effectively and less time asking questions of you and your staff.

  ~~ Page Break ~~


 Student:________________________________ Site:_________________________



  1. What are the student's strengths?






  1. What are the student's weaknesses?




Please rate the student on these questions using the following scale:

 5 (Excellent)    4  (Good)    3  (Satisfactory)    2  (Needs Improvement)    1  (Unacceptable)

  1. Did the student exhibit professionalism in appearance, attendance and time management?

                                      5            4           3           2         1





  1. Did the student show evidence of independent judgment and critical thinking?
                                          5            4           3           2         1

COMMENTS: ________________________________________________________




  1. Did the student demonstrate good oral and written communication skills?
                                          5            4           3           2         1

 COMMENTS: ________________________________________________________




  1. Did the student have an adequate understanding of the concepts to complete the assigned experiences?
                                          5            4           3           2         1






  1. Were there aspects of this internship that you would have liked the student to have covered in more detail?  Please comment on this.                                    

COMMENTS: ________________________________________________________





  1. In your opinion, is this student qualified for a management position?  Please include reasons why or why not.

 COMMENTS: ________________________________________________________





  1. Please rate the student's overall performance during the Internship.
                                          5            4           3           2         1

COMMENTS: ________________________________________________________



Please assign a letter grade for this student (Final responsibility for grades rests with the Program Director).

 A         A-        B+       B         B-        C+       C         C-        Below C-

  1. Please check if you want a copy of the student's evaluation of the Internship site.  [  ]


Signature of Clinical Site Supervisor / Date


This evaluation has been reviewed with me.


Signature of Student   / Date

  ~~ Page Break ~~


Please list the experiences during this internship which you feel demonstrates your participation in the following (attach samples if possible):

Employee relations:

Administrative functions:


Financial data (budget, evaluation cost of new position/equipment)

Committee Meetings:

Re-engineering activities:

Special projects: