NOAH Summer Internship 2018 Application (Due April 15th 11:59pm)
SIP 2018 Application: Call (402) 651-4502 For any Questions

You will need at least 30 minutes to complete this application. You can submit your application until April 15th.

Email address *
Student First Name *
Your answer
Student Last Name *
Your answer
Student Email *
Your answer
Student Home Address *
Your answer
Desired Salary: $/Hour (OR) Total $ amount over this summer?
Your answer
Birth Date *
MM
/
DD
/
YYYY
Age *
Your answer
Gender
Your answer
School *
Your answer
Grade *
Your answer
Parent/Guardian Name (Primary Phone) *
Your answer
Address/ City/ Zip *
Your answer
Do you have any medical conditions?
Your answer
Parent/Guardian Email *
Your answer
What medical careers are you interested in exploring?
What are some qualities you plan to contribute to the 2018 Intern Team? (Minimum 1 Paragraph)
Your answer
What interests you about health related careers? (Minimum 1 Paragraph)
Your answer
What are some community service projects you have participated in OR would like to create? (Minimum 1 Paragraph)
Your answer
Why is community health important? To you? To Omaha/North Omaha? (Minimum 1 Paragraph)
Your answer
Grade Point Average (GPA) *
Interest in Math
Low
High
Interest in Science
Low
High
Interest in History
Low
High
Interest in English/Reading
Low
High
Interest in Public Speaking
Low
High
High School/Address *
Your answer
Did you graduate? *
College/Address
Your answer
Did You Graduate?
Other Education/Certification
Your answer
Professional Reference
List your professional reference below
Full Name
Your answer
Organization
Your answer
Position
Your answer
Phone number
Your answer
Email
Your answer
Personal Reference
List your personal reference below
Full Name
Your answer
Relationship
Your answer
Phone number
Your answer
Email
Your answer
Teacher Reference
List your Teacher reference below
Name
Your answer
Subject
Your answer
Email
Your answer
Phone number
Your answer
Employer/Volunteer Project #1
Name of Company & Supervisor *
Your answer
Job Title & Responsibilities *
Your answer
How Long Did you work there *
Required
Reason For Leaving *
Your answer
Supervisor/Company Contact Phone Number *
Your answer
Employer/Volunteer Project #2
Name of Company & Supervisor
Your answer
Supervisor/Company Contact Phone Number
Your answer
Job Title & Responsibilities
Your answer
How Long Did you work there
Reason For Leaving
Your answer
(Optional) Employer/Volunteer Project #3
Name of Company & Supervisor
Your answer
Supervisor/Company Contact Phone Number
Your answer
Job Title & Responsibilities
Your answer
How Long Did you work there
Reason For Leaving
Your answer
You are applying to intern in a field that allows you great freedom of creativity in effort to solve community health disparities. With great freedom comes great responsibility. What will you do to stay on task and make your time count this summer? (1 paragraph minimum) *
Your answer
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