Internship Application

Name(Required)
MM slash DD slash YYYY
Address(Required)
Are you a Samaritan Employee?(Required)
Are you a Student?(Required)
School Contact Name:(Required)
Drop files here or
Accepted file types: ie, jpg, gif, png, pdf, docx, Max. file size: 2 GB.
    Consent(Required)
    Under the terms of the internship/shadowing opportunities, it is understood that the student/applicant is under the direct supervision of a department manager or designee. Any patient care delivered by the student/applicant (when appropriate) will be under the direction of the department manager or his/her designee and only after student competency has been established and possession of school/personal liability insurance has been confirmed (where applicable). The department manager will secure informed consent from the patient to permit the student to participate appropriately in the provision of patient care. Department managers or designees will accept responsibility for the supervising and directing of students who wish to serve internships/shadowing opportunities with them at Samaritan.
    By checking this box, the student/applicant understands and accepts the educational experience as described above. The student agrees to abide by the rules and regulations of Samaritan.