Volunteer/Internship Form
Complete this form if you are interested in volunteering or doing an internship at UCHC. This form will help us prepare and determine if we have availablity, ample space, devices, etc. Once you have completed the form, a representative from the UCHC management team will contact you. Please note: Only volunteers and interns rotating through an accredited school program will be permitted to participate in deliverying patient care.
Full Name:
*
First Name
Middle Name
Last Name
Contact Number:
*
-
Area Code
Phone Number
E-mail:
*
example@example.com
School/Program (if Applicable):
example: school/program
Are you 18 or older?
*
Yes
No
What is the reason for your internship/volunteer?
*
Applying to medical school or in medical school and need clinical hours
Referred for a clinical rotation from an accredited school
Referred for an admin internship through a school partnership
To observe clinicans in the practice
Just looking to provide help/assistance where needed
Other
What type of setting are you looking to work in:
*
Remote
In-person
Hybrid-a combination of the two
Other
What type of schedule are you looking for?
*
Once a week
Twice a week
Three or more days
No set schedule
Name of person who referred you?
*
When do you plan to start your internship or volunteer service? (please provide approximate date if don't have a fixed date)
*
How long do you plan to do intern/volunteer for, or do you have an end date in mind?
*
What is your expectation of the intern/volunteer program?
*
To gain experience in a health care setting
To get hired if a position becomes available
Other
Any comments or relevant information that you would like to add?
Submit
Should be Empty: