2027 Internships

Internship Request Form

This form is for Dental Clinics with active contracts at Palomar College. If you are interested in receiving interns but do not have a contract with us yet or need to renew a contract, please send an email to dentalassist@palomar.edu.

Dental Office Contact Information

Please state the contact information for the point of contact for this location.

Dental Office(Required)

EIN/license number(Required)

Type of Office

Office Contact Name(Required)

Title(Required)

Contact Email Address(Required)

Email Address Confirm Email

Phone(Required)

Office Address(Required)

Address City State Zip

Does your office have an RDA on staff?

Yes

Hours Available

Palomar College Dental Assisting interns are assigned Monday, Tuesday and Thursday every week between the 2nd week of January to the 2nd week of May, except the first two weeks where students can intern Mondays thru Fridays to complete 50 hours. Please indicate the times they will be expected to start work, when your office has a scheduled lunch break, and the time your office closes. NOTE: Students must be dismissed by 7pm. For Session I the student will directly coordinate with you in completing the 50 clinical hours they need. The rest of the schedules will be done Mondays, Tuesdays and Thursdays.

Monday Hours(Required)

Start Time (ex. 8 AM)

Lunch Break (ex. 12-1 PM)

End Time (ex. 5 PM)

Tuesday Hours(Required)

Start Time (ex. 8 AM)

Lunch Break (ex. 12-1 PM)

End Time (ex. 5 PM)

Thursday Hours(Required)

Start Time (ex. 8 AM)

Lunch Break (ex. 12-1 PM)

End Time (ex. 5 PM)

Sessions Available

Three sessions are available to host Palomar College Dental Assisting interns. Please indicate which session(s) and the number of interns your office can accommodate.

# of Interns for Session I(Required)

Session I: January 14-29

# of Interns for Session II(Required)

Session II: February 8 to March 11

# of Interns for Session III(Required)

Session III: March 15 to April 23 (excludes Spring Break March 29 to April 2)

Does your clinic require the student to submit any forms or documents? Ex. Proof of immunizations, etc.(Required)

Yes

Please list your requirements below(Required)

Contact Person and Number the Student will Contact(Required)

The student will contact this person after being assigned to your site.