Summer ISH Intern Programs

First Name :

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Last Name :

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Current Address:

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City:

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State:

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Zip Code:

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Phone:

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Expected format: (xxx-xxx-xxxx)

Email:

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Confirm Email:

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This needs to match the value of the previous field.

T-Shirt Size:

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School Name:

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Education Level:

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This can include your highest level of education or where you are at in your current program.

Are you under the age of 18?:

Students who are under 18 will need to provide parental information and consent.

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Yes

No

List all of the languages that you speak fluently:

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Please classify your household's income level:

Question is for grant purposes only. Income level plays no factor in selection.

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Low

Low to Moderate

Moderate

Moderate to High

High

How did you hear about us?:

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School

Social Media

Friend or Family Member

Other

Departments Requested:

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Provide a short bio about yourself (Your bio will be used if you are selected for the program):

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What degree are you looking into/currently pursing? What is your future career path goal:

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List and explain any previous background experience you have in the healthcare field:

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List any current certifications:

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What are your strengths and weaknesses/opportunities for improvement:

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Tell us what would set you apart from other applicants:

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What is your main interest in doing the summer intern program:

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List education topics you would like to learn about in the healthcare field:

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What is something you hope to learn or experience during your internship?:

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Provide information on your schedule during the summer intership timeframe. (ex. involved in sports, work a secondary job, etc.) This does not affect the selection process for the program.:

Give us an example of a problem, which you faced on any job you have had, and how you went about solving it:

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If a patient was confused/lost in the hallway, what do you do :

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If you were a superhero, what would your power be and why:

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Summer Intern Program

Please complete the Summer Intern application below to be considered for the program.

Belmond Campus

Clarion Campus

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