Internship 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 Administrative Specialist for any questions.

Today's Date

Your Name(Required)

First Last

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)

Public Health Areas of Interest(Required)

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?(Required)

Computer Skills (include programs you are proficient in(Required)

Other Skills/Trainings/Abilities:(Required)

What are your professional objectives for this internship/practicum?(Required)

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

My future career aspirations include...(Required)

Academic Advisor's Name

Academic Advisor's E-mail

Please Attach your Resume(Required)

Accepted file types: pdf, doc, docx, Max. file size: 10 MB.

Additional Comments(Required)

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210 East Walnut Street Nicholasville, KY 40356

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