AODS Certification Program

Internship Partnership Request Form

Program Coordinator
Jim Fent, LMFT, PT, SUDCC IV, CADC-III
MD Building, Office #243
(760) 744-1150 x2188
jfent@palomar.edu

Professor
Nicole Rose
(760) 744-1150 x3281
nrose@palomar.edu

Academic Department Assistant
(760) 744-1150 x3346

Business Name / Organization(Required)

Name

Your Name(Required)

First Last

Physical Address

Street Address Address Line 2 City ZIP Code

Preferred Method of Contact

Your Email Address(Required)

Email Address Confirm Email Address

Your Phone(Required)

Internship Type(Required)

Level of Commitment(Required)

Intern Expectations / Requirements(Required)

Additional Information

Palomar College, San Marcos Campus Location: MD

1140 W. Mission Road, San Marcos, CA 92069

James Fent

Program Coordinator Email: jfent@palomar.edu Phone: (760) 744-1150, ext. 2188

Nicole Rose