Intern Application Form
At the Health Collective, our internship program offers hands-on learning experiences for students and emerging professionals passionate about health equity and community care. Interns can choose to explore meaningful opportunities within our Development, Medical, Dental, or Community Engagement departments. Whether you're assisting with grant writing, supporting clinical staff, promoting wellness initiatives, or organizing events, you'll be part of a mission-driven team dedicated to inclusive, person-centered care. Interns gain real-world experience, mentorship, and the chance to make a lasting impact in the communities we serve.
Student Name
*
First Name
Middle Name
Last Name
Pronouns
*
I.E .She, He, They, Zir
Birth Date
*
Please select a month
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Month
Please select a day
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Day
Please select a year
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Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
College/University Name
*
University of Connecticut, Gateway, etc
Major
*
Political Science, Communications, Business, etc
Student E-mail
*
example@example.com
Mobile Number
*
Choose your semester session:
*
Please Select
Fall
Winter
Spring
Summer
Departments you would like to intern under:
*
Please Select
Dental
Medical
Community Engagement
Development
Health Collective East (Food pantry, and support groups)
Additional Comments
Submit
Should be Empty: