Application Form for Community Health Internship

Personal Information

First Name

Last Name

Phone Number

Address

City

State

Zip Code

Date of Birth

College or University

University Address

University Email Address

Advisor Phone

Advisor Email

University Contact Advisor

Current Year of Study

Major

Dual Major or Minor (if applicable)

Graduation Date

Degree

Have you ever been employed by LGH?

If so, what dates & department?

Internship Opportunities & Interests

What do you hope to gain from the internship?

Will you receive college credits for this internship?

Desired Start Date

Approximate End Date

Minimum Hours Per Semester/Internship

Desired Schedule (Include days of the week and number of hours per week)

Select from the available internship opportunities based on your level of interest.

First Choice

Second Choice

Third Choice

I understand that if selected for an internship position with Community Health and Wellness that the position will be unpaid by Lancaster General Health.