Form
Name
First Name
Last Name
Email
example@example.com
Phone Number
Please enter a valid phone number.
What High School did you attend in May of 2025
What Grade are you currently
Please Select
Graduating Senior
Finishing Junior Year
Finishing Sophomore Year
Other
Spanish Language Level
Please Select
None
Very Little
Can get by
Conversant
Fluent
Previous Health care Experience
Why are you interested in an internship at Volunteers in Medicine?
List any specific goals, interests or skills that would make your time at VIM more meaningful
Willing to undergo a background check and participate in HIPAA and other trainings as deemed necessary by VIM staff
Yes
No
Any medical concerns or accomodations that VIM should be aware of?
Yes
No
Please provide the name and contact information of one non-family reference
Teacher, former boss, coach
Submit
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