Internship Placements at UCD Charles Institute- Student Expression of Interest Form

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Please complete the following form if you are interested in doing a placement; internship at the UCD Charles Institute of Dermatology

Email *

Name *

Are you over 18 years old? *

Name of your Home University/College: *

e.g. University of Edinburgh

Name of Home Institution; School *

e.g. Charles Institute of Dermatology School of Medicine

Are you an Undergraduate or Postgraduate student? *

Highest Qualification Achieved *

BSc, MSc etc.

Name of Programme and modules you are registered to: *

Stage in Programme at Home Institution (e.g. 1st, 2nd, 3rd or , 4th year): *

Thematic; Research Area of Interest (please see https://www.ucd.ie/charles/research/thematicareas/ for more information) : *

Is there a specific lab group in the Charles Institute you would like to work with?

Please describe your level of lab experience to date; any specific techniques you would like to be trained in: *

Will there be a formal hosting agreement between UCD and your home university; institution or will this be an informal placement between you and UCD? *

Will you have any funding? *

Proposed Internship Placement Start Date: *

At Host Institution

YYYY

Proposed Internship/ Placement Duration (in weeks) *

Will this placement be credit-based; if so how will it be assessed? *

PI/Supervisor at home institution: *

What are the desired learning objectives you hope to achieve following the conclusion of the internship? *

Any Comments:

A copy of your responses will be emailed to the address you provided.

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