Internship/Practicum Interest Form

Thank you for your interest in interning at the Jessamine County Health Department. For your convenience, please complete the Internship/Practicum Interest Form below. You will be contacted within two weeks of submission.

Contact our Director of Administrative Services for any questions.

Today's Date

Your Name (required)

Your Email (required)

Subject
Student Internship/Practicum

Your Academic Institution (required)

Degree In-Progress (required)

Is an internship, service learning experience, observation or rotation required for your degree? (required)

 Yes No

Public Health Areas of Interest (required)
 Accreditation Administration Clinic (Nursing) Community Health/Health Education Environmental Health Epidemiology/Communicable Disease H.A.N.D.S. Preparedness Worksite Wellness

Internship/Practicum Semester (required)

Anticipated Start Date (required)

Anticipated End Date (required)

Total Internship/Practicum Hours Required (required)

Why are you interested in interning at the Jessamine County Health Department?

Computer Skills (include programs you are proficient in):

Other Skills/Trainings/Abilities:

What are your professional objectives for this internship/practicum?

I am a great candidate for this internship/practicum because...

My future career aspirations include...

Academic Advisor's Name:

Academic Advisor's E-mail:

Please Attach your Resume

Additional Comments