LCPH Internship Application

Internship Application

This form will take approximately 20 minutes to complete.
Student Information
Name*

First NameLast Name
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone*
Email*
example@example.com
Which semester are you applying for?*

Fall semester (application due no later than September 1)Spring semester (application due no later than December 1)Summer semester (application due no later than May 15)

Education
Academic Institution Currently Attending*
Academic Institution Currently Attending*

FreshmanJuniorMaster’s Degree StudentSophomoreSeniorDoctoral Degree Student
Degree Major*
Faculty Advisor Information
Advisor's full name*

First NameLast Name
Phone*
Email*
example@example.com
Total Internship Hours Required*
Hours Per Week*
Anticipated Start Date*

MonthDayYear
Date
Anticipated End Date*

MonthDayYear
Date

I am interested in this opportunity because (i.e. what I hope to gain from an internship with Lewis and Clark Public Health)*
Please verify that you are human*
Should be Empty:

Internship Application