Internship Inquiry

Luna Lactation Internship Inquiry Form
Name*

First NameLast Name
Email*
example@example.com
Phone Number*
Please enter a valid phone number.
Why do you want an internship with Luna Lactation?*
What lactation education have you already completed or plan to complete?*
What are your goals?*
What amount of hours do you need?*
Preferred start date*
Preferred days of the week*
Do you already carry liability insurance as a student IBCLC?*

YesNoOther
Luna Lactation requires all interns and staff to be fully vaccinated for Covid-19. Are you fully vaccinated for COVID-19?

YesNo
Please upload a picture of your COVID-19 vaccination card*

Cancelof
By signing below, I am agreeing to the following:
- I understand Luna Lactation requires interns to practice inclusively and ethically.
- I understand that Luna Lactation typically charges $15 per internship hour.
- I agree to behave professionally at all times.
- I understand that I must comply with the rules of HIPAA.
Signature*

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Luna Lactation Internship Inquiry Form