HERIF Internship Application Form

Internship application

Thank you for your interest in the Healthcare Career Exploration Internship.
Full Name

First NameLast Name
Preferred Name
Gender

MaleFemaleNon-BinaryPrefer Not to SayOther
Birth Date

MonthDayYear
Age
E-mail
example@example.com
Home Number
Cell Number
Permanent Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Are you authorized to work in the United States?

YesNo
What Internship opportunity are you interested in?
Education
Name of High School
Name of College
School Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Major
Year
Other College(s) info

Interest in Healthcare:
What sparked your interest in the healthcare or medical field? (150–200 words)
Learning Goals
What do you hope to learn by participating in this internship with healthcare professionals? (150–200 words)
Community or Service Experience
Describe a time when you volunteered, helped your community, or worked on a team project. What did you learn from that experience?(150–200 words)
Personal Motivation
Why are you interested in this internship specifically with our organization?(150–200 words)
Availability
Are you available to attend the internship sessions in person?

YesNo
Days available:

MondayTuesdayWednesdayThursdayFriday
Should be Empty:

Education