Internship with Larimer County Department of Health & Environment
Full Name
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First Name
Last Name
E-mail
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Address
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Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Phone Number
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Area Code
Phone Number
School you are currently attending
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Type of education program you are currently enrolled in:
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Undergraduate
Graduate
Masters of Public Health
Traditional BSN
Non-traditional BSN
Masters in Nursing Education
Nurse Practitioner Program
Other Nursing Program
Other
If other please specify.
Highest level of Education Completed
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High school
Some college
Undergraduate degree
Master's Degree
Other education or professional licensure
If you currently have a degree, what is it in?
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Please specify primary area of study, degrees, education, or professional licensure
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If this is tied to school semesters, which semester would you be working for?
Upcoming Summer Semester
Upcoming Fall Semester
How long of a commitment will you make?
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How many hours do you need to fulfill?
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Is this a specific school program requirement? Which one?
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Capstone
Practicum
Other
None
When will you graduate?
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Month
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Day
Year
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Is there an evaluation component to your time spent with Larimer County Health Department?
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Yes
No
Are you proficient in any language other than English? Please specify
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What program area are you interested in?
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Tobacco Prevention
Emergency Preparedness
Health Education/Communication
Zoonotic Disease Surveillance
Environmental Health
Other
Please describe why you are interested in working for Larimer county Health and Environment
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Please describe what skills and experience you hope to gain by working with Larimer County Health and Environment
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When would you be interested in starting?
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Month
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Day
Year
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When would your end date be?
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Month
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Day
Year
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How did you find out about this opportunity with Larimer County Health and Environment?
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Referred by staff
Referred by friend
Larimer County website
Other
We require our interns to be up-to-date on vaccinations and provide immunization records prior to the start of an internship. By submitting this form, you agree to provide your immunization records to LCDHE and prove that you are appropriately vaccinated. If you are not up to date or are unwilling to provide proof of your immunization status, you will not be considered for an internship with Larimer County Health Department
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