Online Internship Application Form

Personal Information
Full Name

First Name Last Name
Preferred Name
Gender

Male Female
Birth Date

Month Day Year
Age
E-mail
example@example.com
Home Number
Cell Number
Permanent Address

Street Address

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City State / Province

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Can you provide proof of eligibility to work in the United States?

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The pre-nursing internship is between 10 to 20 hours a week, how many hours would you like to work?
Education
Name of College
School Address

Street Address

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Major
Year
Other College(s) info
High School - City - Dates

Describe any experience you have had with older people.
Describe why you are interested in nursing?

Employment
Place
Date

Month Day Year
Date
Title
Place
Date

Month Day Year
Date
Title
References
Name

First Name Last Name
Relationship
Name

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Relationship
Acknowledgement
I have read the internship job descriptions and I fully understand the requirements, pay if any, and employment start and end dates. *

Yes

The Kaylynn Koon Pre-nursing Internship

in geriatrics and long-term care

The Kaylynn Koon pre-nursing internship at Robville Homes, LLC in Pullman, Washington is awarded to one pre-nursing student at Washington State University per calendar year. The internship is intended to give awardees the opportunity to develop skills and passion for the care and well-being of our elders. Robville LLC is an adult family home nestled in a residential neighborhood specializing in geriatric care and dementia care. It is a full-service assisted living facility in a large home overlooking Kamiak Butte.

The internship is paid at regular caregiver wages for 10-20 hours per week depending on the awardee’s needs and schedule. Additionally, on-line coursework to obtain the required CNA either through HCA and then a bridge course to the CNA or a direct CNA course is funded and supported by Robville.

The internship awardee is supervised by a 15-year veteran of long-term care management whose patient and knowledgeable guidance is second-to-none.

The internship is named after the first intern, Kaylynn Koon, whose passion, and initiative created the impetus for funding this project.
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