South Heartland District Health Department

APPLICATION FOR INTERNSHIP 

SOUTH HEARTLAND DISTRICT HEALTH DEPARTMENT 

First Name*  Middle Name*  Last Name* 

Email Address*  

School Address1* 

Address2  

City*  State*  Zip* 

Phone Number* (XXX-XXX-XXXX)  

Anticipated Date of Graduation:  

Major:  Cumulative GPA:  

Date Available to Begin Internship:   Number of Hours Available Per Week:  

What is your career goal?

How will this internship help you reach your career goal?

Describe the qualities that make you a candidate for this internship?

I am most interested in (please rank, with 1=most interest and 6=least interest): 

Health & Wellness Education 

Public Health Environmental Risk and Emergency Preparedness 

Chronic Disease Prevention 

Disease Control & Prevention and Health Surveillance

Cancer Prevention

Minority Health Education

Accounting & Business Administration; Policies and Plans

Please attach your resume below:*

File:

Comments:

Signature of Applicant:  Date: 

*required fields