Internship 2017

Full Name *

First Name Last Name

E-mail *

Address *

Street Address
Street Address Line 2
City	State / Province
Postal / Zip Code	Country

Phone Number *

Area Code Phone Number

School you are currently attending *

Type of education program you are currently enrolled in: *

If other please specify.

Highest level of Education Completed *

High school Some college Undergraduate degree Master's Degree Other education or professional licensure

If you currently have a degree, what is it in? *

Please specify primary area of study, degrees, education, or professional licensure *

If this is tied to school semesters, which semester would you be working for?

How long of a commitment will you make? *

How many hours do you need to fulfill? *

Is this a specific school program requirement? Which one? *

Capstone Practicum Other None

When will you graduate? *

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Is there an evaluation component to your time spent with Larimer County Health Department? *

Yes No

Are you proficient in any language other than English? Please specify *

What program area are you interested in? *

Please describe why you are interested in working for Larimer county Health and Environment *

Please describe what skills and experience you hope to gain by working with Larimer County Health and Environment *

When would you be interested in starting? *

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When would your end date be? *

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How did you find out about this opportunity with Larimer County Health and Environment? *

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

Internship with Larimer County Department of Health & Environment