2025 Summer Health Internship Program (SHIP) Application

I. DEMOGRAPHICS
First Name:
MI:
Last Name:
Current Address:
Where will you be living this summer?
City:
State:
Zip Code:
Permanent Address:
City:
State:
Zip Code:
Primary Phone:
Alternate Phone:
Email Address:
Gender:

MaleFemale
Date of Birth:

MonthDayYear
Date
What location do you consider your hometown?
County Name:
City:
State:
Zip Code:
II. EDUCATION
High School
High School:
Graduation Year:
City:
State:
Zip Code:
College/University
University/College Name:*
Classification:*
City:
State:
Major:*
Minor:*
Degree*
When do you expect to complete this degree?*

SpringSummerFall
Year:
If you have already completed a degree, please indicate the date your degree was awarded.

MonthDayYear
Date
What is your current cumulative grade point average? (Please note that those with a GPA of less than 2.75 are not eligible to apply to the SHIP Program.)*
What are your current plans for the upcoming fall semester?

Continue undergraduate studiesBegin a graduate programEmploymentOther
Please describe your career plans and anything else you would like to tell us about your academic interests or plans for future study.
III. WORK EXPERIENCE
Please describe up to three of your most relevant work (paid) experiences. Begin with your most recent experience.
Work Experience #1
Organization:
Position Held:
City:
State:
Zip Code:
Name of Supervisor:
Dates of Service:
Summary of Duties:
Contact Person for Reference: (title, phone number with area code, email address, best time to contact, etc) - OPTIONAL
Work Experience #2
Organization:
Position Held:
City:
State:
Zip Code:
Name of Supervisor:
Dates of Service:
Summary of Duties:
Contact Person for Reference: (title, phone number with area code, email address, best time to contact, etc) - OPTIONAL
Work Experience #3
Organization:
Position Held:
City:
State:
Zip Code:
Name of Supervisor:
Dates of Service:
Summary of Duties:
Contact Person for Reference: (title, phone number with area code, email address, best time to contact, etc) - OPTIONAL
IV. SKILLS
Please indicate the skills and/or experiences you bring to the program. (Check all that apply)

Excel spreadsheetsAccess databaseAdvanced computer skills (website design, graphic design, GIS mapping)Data (collection, analysis, database development)Working with special populations (elderly, youth, minority, etc)Administrative skills (organization, event planning, customer service, program development)Research (survey design, focus groups, literature searches, statistical methods, program evaluation)Communication (teaching, public speaking, interviewing, group facilitation)Marketing and public relationsWriting/editing (newsletters, lesson plans, reports, scientific articles, grants)Environmental samplingLaboratory skillsPhotographyOther
List all languages, in addition to English, that you are proficient in reading, writing and/or speaking:
Do you have a valid driver's license? Some internship sites require use of a vehicle. This information will help us to place you appropriately.

YesNo
If Yes, will you have the use of a personal vehicle with automobile liability insurance during the summer?

YesNo
Please explain any special circumstances you would like to be known in considering you for the SHIP Program:
V. REFERENCES
Two letters of recommendation from college faculty or previous employer are required. These can be emailed directly from the reference to Lakyn Newcomb at Lakyn.Newcomb@st-claire.org or can be submitted here below.
Letter of Recommendation #1

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Letter of Recommendation #2

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VI. TRANSCRIPTS
You must provide transcripts for your academic work. You may upload a copy of your most current official or unofficial college transcript, and any other transcripts from academic programs where you completed 12 credit hours or more. If your current or degree-granting transcript includes transfer credit grades and/or GPA, you do not need to request additional transcripts.

Transcripts may also be emailed directly from the university to Lakyn.Newcomb@st-claire.org or submitted here below.
Please list all colleges / universities you have attended:
School #1 (most current):
School #2:
School #3:
Please list any additional schools here:
Upload college transcripts here:

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VII. STUDENT PROFILE
Extracurricular Activities: List the extracurricular activities you have been in, or are currently involved with, and provide a description of your contribution to each activity. Also provide the calendar year(s) in which you participated in each activity.
Service (unpaid): List your volunteer experiences. Explain your specific responsibilities and provide completed and current date(s).
Honors/Awards (BE SPECIFIC): List honors and awards you have received. Please do not list involvement in organizations and clubs unless you have been elected to an office or selected for a specific honor. Do not abbreviate award names, for example: National Honor Society - NHS. Also include the year(s) in which you received the honor or award.
VIII. YOUR INTERNSHIP PREFERENCES
Specific projects are selected after admission to the program. If you have a location preference, you may indicate that below.
If selected for SHIP, I am interested in placement in:

BathBoydCarterClarkElliottFlemingGreenupLawrenceLewisMasonMenifeeMontgomeryMorganNicholasPowellRobertsonRowanNo Preference
1st Choice:
2nd Choice:
3rd Choice:
4th Choice:
5th Choice:
Is there anything else we need to know about your assignment preferences?
IX. ESSAYS
Please provide two (2) essays. Documents must be TYPED, DOUBLE-SPACED, and attached to this application.
Essay #1 - Please introduce yourself and explain what attracts you to the health field, as well as your career ambitions. (Approximately 250 words.)*

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Essay #2 - Please explain what you hope to gain from this internship, how you believe this internship may impact your career ambitions, and what sets you apart from other applicants. (Approximately 250 words.)*

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X. STUDENT CONSENT AND AGREEMENT
By my digital signature below, I hereby certify that the information provided on this application and attachments I have provided is true and accurate to the best of my knowledge and that the writing entry is my original work. I commit myself to abide by the rules and expectations of the SHIP Program.
Signature
Date:

MonthDayYear
DateHourMinutesAM/PM Option
Should be Empty: