Adobe FormsCentral

Fall 2026 Church Health Internship Application

**Please note that this application is ONLY for those wishing to serve as interns in the FALL of 2026.**
CONTACT INFORMATION
LAST NAME:
FIRST NAME :
EMAIL:
example@example.com
PHONE NUMBER:
Birthday

MonthDayYear
EDUCATION

Please give the information for the school you currently attend. If you are not in school, please list the information for the school of the higest degree/certificate you have received.
NAME OF SCHOOL:
CITY AND STATE:
MAJOR
CURRENT CLASSIFICATION:
DEGREE:
GRADUATION YEAR OR ANTICIPATED GRADUATION YEAR:
Are you applying for academic credit for this internship?
If yes, please indicate how many hours are required for academic credit, and your advisor's name and contact information.
Please note: Church Health does not have any clinical or preceptor opportunites available for graduate students.
OCCUPATIONAL HISTORY

Please describe your previous work experience (paid and volunteer), beginning with the most recent. Failure to provide any work or volunteer history will be considered an incomplete application and will not be considered.
EMPLOYER AND LOCATION:
DATE STARTED:
DATE ENDED:
RESPONSIBILITIES:
EMPLOYER AND LOCATION:
DATE STARTED:
DATE ENDED:
RESPONSIBILITIES:
REFERENCES

Please list two professional or academic references. These should not be friends or family members.
NAME OF REFERENCE:
RELATIONSHIP TO YOU:
PHONE:
EMAIL:
NAME OF REFERENCE:
RELATIONSHIP TO YOU:
PHONE:
EMAIL:
SHORT ANSWER QUESTIONS
What particular skills, talents or gifts do you have that would be an asset to Church Health? Please include any foreign languages and your proficiency level.
What are your short and long-term goals? How will an internship at Church Health help you to achieve these goals?
Please describe any work or volunteer experience that you have had and describe the impact that these activities have had on your life.
AVAILABLE POSITIONS

Please reviw the internship descriptions on our website for more information about each of these opportunities.
With which department would you like to intern: First Choice
Second Choice
*The Child Life Internship requires previous experience with children. If interested in the Child Life internship, please describe your experience in childcare, education, or other relevant experience. ** You must also pass a background check, which requires a SSN.
How did you hear about the Church Health internship program?
Please indicate whether you would be interested in being considered for other areas if you are not selected for your preferred positions.
INTERNSHIP COMMITMENT

Church Health requires interns commit to working at least 10-12 weeks and for no less than 8 hours per week (12 hours per week for child life).

Church Health is only open during business hours, Monday-Friday, with the exception of Child Life (The Well), which does offer evening/weekend hours. If you do not have any availability on weekdays from 8am-5pm, please do not submit this application unless applying for The Well.
What days and times do you anticipate being able to work at Church Health?
ADDITIONAL DOCUMENTS
Please attach your current resume or any other supporting documents that you would like the Internship Coordinator to review.
Attachment(s)

Cancelof
I hereby authorize Church Health and/or its agents to conduct such investigation of my intern application as considered necessary. I authorize any and all former employees and/or business references to furnish information concerning my past job performance, work and educational histories. I release any liability the above named individuals furnishing such information. I recognize a photocopy of this authorization is a valid requisition. I understand that any false statements on my application are grounds for dismissal or withdrawal of any offer of employment.
ELECTRONIC SIGNATURE:
DATE:
Should be Empty:

Fall 2026 Church Health Internship Application