SMD Unpaid Academic Internship and Shadowing Program Application Form

Please complete* this form electronically. Scanned and/or printed forms will not be accepted. You are allowed to leave the survey and return later.

*It is the Hosting Department's responsibility to complete this form. Prospective interns/shadows are not to complete the form under any circumstances. Applications submitted by prospective interns/shadows will not be accepted.

Internships and shadowing experiences are not organized by this Program. Individuals should visit URMC's Departments & Centers listing to determine where they would like to seek an internship/shadowing experience, then contact that department to inquire about an opportunity.

Check the Program Selection Grid for URMC Educational Experiences to determine whether this is the correct program for the interested party. Email SMD-Internship-Program@urmc.rochester.edu for more information.

Refer to the Program Requirements and FAQs as needed.

Thank you!

High School Diploma

Associate's

Bachelor's

Master's

PhD

Other Doctoral

Certificate

Other

None

Yes

Yes

Yes

For interns and shadows under 18 years of age, the Parental Consent Form must be completely filled out, signed, and submitted with this online application form.

Attachment:

Parental Consent Form.pdf

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For interns and shadows under 18 years of age, the Adult Supervisor's Training Compliance Form must be signed and submitted with this online application form.

Attachment:

Supervisor Training Compliance Form.pdf

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The Department Administrator is responsible for completing the Background Check Process.

This application will not be reviewed until proof of required Background Checks has been received. Interns/shadows under 18 may not start until all requirements are completed.

Adult supervisors include the intern/shadow's advisor and any delegates that may supervise the intern/shadow.

Attachment:

Background Check Process.pdf

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Yes

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Is this an internship or shadowing experience?

An internship is appropriate if there is to be a legitimate learning experience that will benefit the student as an extension of his/her academic experience. An internship offers the student an opportunity for active and engaged training under constant supervision.

A lab/research shadowing experience is appropriate if the individual will be doing no work, will be constantly supervised, and will simply be observing his/her supervisor. Shadows may only perform minimal mirroring of experiments, techniques, etc. Shadows may not have any hands-on patient contact.

* must provide value

Internship

Shadowing Experience

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The intern must obtain a statement from their school which attests that s/he is a student whose course of instruction leads to a degree, diploma, or certificate. This statement must be on school letterhead and may be from the school's Registrar or from a professor at the school. The statement should include the current registration status and the expected degree completion date. The Hosting Department must submit the statement with this application.

Graduating high school seniors must obtain a statement from their post-secondary institution. A copy of the receipt/confirmation of deposit is acceptable. Undergraduate, graduate, and other students who are transitioning between degree programs must provide a statement from both their current and future institutions.

* must provide value

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Yes

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Shadowing experiences may last no longer than 160 total hours over the course of 6 months, and may not be renewed.

This shadowing experience may last no longer than 160 total hours over the course of 6 months, and may not be renewed.

M-D-Y

The Hosting Department is responsible for complying with all policies and training requirements in a timely manner. Compliance-related documentation should be retained at the departmental level. The Department must be able to produce all documentation within 24 hours for audit purposes. The Department may also have additional, department-specific, policy/training requirements.

Yes

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The Environmental Health & Safety Guidelines for Visitors to Laboratories must be adhered to and any related lab safety training is required.

Attachment:

EH&S Guidelines for Visitors to Labs.pdf

Yes

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An Intellectual Property Agreement is required.

Attachment:

Intellectual Property Agreement.pdf

Yes

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HIPAA Privacy and Security training and Mandatory In-Service training are required.

Attachment:

HIPAA & Mandatory In-Service Training.pdf

Yes

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Compliance with Strong Memorial Hospital Policy 12.07 is required.

Please note: A person interested in clinical shadowing only does not need to apply to this Program. Compliance with SMH Policy 12.07 is sufficient.

Attachment:

SMH Policy 12.07 Short-Term Observational Experiences.pdf

Yes

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Compliance with Strong Memorial Hospital Policy 12.07 is required, and a Health Assessment via University Health Service is also required.

Attachment:

Health Assessment via University Health Service.pdf

Department Chair approval and an Affiliation Agreement (SMH Policy 12.05) are also required. SMD-Internship-Program will advise you on this.

Attachment:

SMH Policy 12.05 Affiliations with Other Institutions for Educational Purposes.pdf

It is required that the individual be supervised at all times either by the Advisor or an appropriate delegate.

The renewal application must include new educational goals and nature of work.

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Oral report - presented to the lab group or to a wider audience

Poster - presented at a formal poster presentation of some kind

Written report - provided to the Advisor

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