Everyone interested in an internship must complete the following requirements:
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Affiliation agreement between program and hospital
- Student acknowledgement statement
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Documentation of a two-step TB skin test or two consecutive years of a one-step
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Immunization confirmation statement that your immunizations are up to date, on file and that you are free of infectious disease. This verification agreement must be signed by your school's program director or coordinator. If files are not up to date, please sign the
disclaimer form.
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Copy of criminal background check
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Liability insurance provided by program or individual
Please print out and complete all of the above forms. You must have the forms sent in to Aultman two weeks prior to starting your experience. Please mail to:
Aultman Hospital
ATTN: Eric Dublikar, Education and Development
2600 Sixth St. S.W.
Canton, Ohio 44710
You will not begin your clinical experience unless all of the documents and forms are properly completed and submitted. We will try to accommodate you as best we can, but you are not guaranteed the dates requested. You will be notified upon acceptance of your documents and application.
Evaluation
After completing your internship, please complete the Evaluation of Aultman and return it to the address listed on the form.
