Questionnaire

Thank you for your interest in either the Physical Therapy or Occupational Therapy Internship (Bio 498). Dr. Jim MacKenzie is the faculty sponsor for this program. This 2-credit hour internship is specifically designed for Juniors and Seniors that need extensive hands-on experience to gain admission into a DPT or OT program. Please be sure to fill out all of the fields to the best of your ability. No single answer here will qualify/disqualify you for getting an internship position, it just gives us an opportunity to learn something about you.

Minimum requirements: sixty (60) earned credit hours, two completed semesters of study at SUNY Oswego, a cumulative GPA of at least 3.0 AND evidence of progression towards application to a DPT or OT program.

Current Standing: Junior Senior

Classes taken/taking: Gen. Chem. Gen. Bio. (Bio120) Human Anatomy-Physiology
Physics Statistics Psychology

Cumulative GPA:

Science Courses GPA:

Have you ever had a shadowing experience with a Physical or Occupational Therapist? Yes No
If yes, where and for how long?

Career Goals:

Do you have a car?  Do you have a job? If yes, where and how many hours a week?


I hereby give my permission to Dr. MacKenzie to review my transcripts and talk with other professors, with the understanding that everything will remain confidential.
I agree
I disagree

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