Internship

Complete this form if you would like to be considered for an internship with MIPH.

Full Name: *

Street Address: *

City, State, Zip: *

Daytime Phone: *

Email: *

School you are attending: *

Your Advisor: *

Year in School: *

You Major: *

Your Minor: *

Date you can start: *

When are you available? (Days and times specifically): *

Are you paying college tuition for this internship?: *

If yes, what type of college credit will you receive from this internship?:

What are your career goals?: *

List any experiences, skills or qualifications that you believe would enhance your internship: *

List any memberships or affiliations you have:

Do you have any specific public health interests?: *

What do you expect to learn from this internship or what are your goals for this internship?: *

Please list three personal references, other than family members. Include their name address and phone number.: *

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Minnesota Institute of Public Health