Application Form for Community Health Internship
Personal Information
First Name
Last Name
Phone Number
Address
City
State
Zip Code
Email
Date of Birth
College or University
University Address
University Email Address
Advisor Phone
Advisor Email
University Contact Advisor
Current Year of Study
Please select...
Freshman
Sophmore
Junior
Senior
Grad
Major
Dual Major or Minor (if applicable)
Graduation Date
Degree
Have you ever been employed by LGH?
Please select...
Yes
No
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?
Please select...
Yes
No
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
Please select...
Community Health Data
Community Health Needs Assessment and Program Evaluation
Mental Health/Substance Use Disorder (not direct patient care)
Children's Advocacy Center
Dietetics/Nutrition
Health Literacy/Patient Education
Social Determinants of Health
Second Choice
Please select...
Community Health Data
Community Health Needs Assessment and Program Evaluation
Mental Health/Substance Use Disorder (not direct patient care)
Children's Advocacy Center
Dietetics/Nutrition
Health Literacy/Patient Education
Social Determinants of Health
Third Choice
Please select...
Community Health Data
Community Health Needs Assessment and Program Evaluation
Mental Health/Substance Use Disorder (not direct patient care)
Children's Advocacy Center
Dietetics/Nutrition
Health Literacy/Patient Education
Social Determinants of Health
I understand that if selected for an internship position with Community Health and Wellness that the position will be unpaid by Lancaster General Health.