Community Health Initiative (CHI) Internship Application (Organization Form)
INCOMPLETE APPLICATIONS AND THOSE ORGANIZATIONS NOT MEETING THE PROGRAM REQUIREMENTS WILL NOT BE CONSIDERED. FOR MORE INFORMATION, PLEASE GO TO THE CHI WEBSITE:
https://bced.umn.edu/CHI/Internship
* Required
General Information
Organization Type
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Nonprofit
Business
Organization Name
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Your answer
Contact Person Name & Title
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Your answer
Executive Director or Business Owner(s)
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Your answer
Street Address (including Suite or Room #)
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Your answer
City
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Your answer
State
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Your answer
Zip Code
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Your answer
Phone
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Your answer
Fax
Your answer
E-mail
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Your answer
Web Page
Your answer
Year Established
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Your answer
Number of Full-Time Employees
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Your answer
Number of Part-Time Employees
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Your answer
Organization Description
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Your answer
Community Internships are available in the following areas. Please check the topical area(s) for which you are requesting a summer intern.
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DO NOT CHECK MORE THAN TWO CATEGORIES
Public Health
Community Health Education
Social Work
Population Health Coordination
Nursing Care/Management
Health/Medical Research
Feasibility Study
Program Evaluation/Measurement
Program Development
Community Outreach
Communications/Event Planning
Other:
Required
Do you have an MSW, MPH or equivalent on your Staff?
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Yes
No
Will this Internship proposal have the capability to be Remote only or a hybrid of Remote and In-Person implementation?
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Yes
No
If you are interested in working with a particular student, please provide their name and e-mail address. (NOTE: the Student must also apply and request you for their Internship Organization.)
Your answer
Internships can be full-time (40 hrs/wk), 3/4 -time (30 hrs/wk) or part-time (20 hrs/wk). Please indicate your preference. Do NOT select more than two options.
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NOTE: Total number of hours below are based on a 12-week timeframe. Although the duration of the internships is from the end of May to August (approximately 14 weeks), internships can start and end anytime within this period.
Full-time (max 480 hours) - approx 40 hrs/wk
3/4-time (max 360 hours) - approx 30 hrs/wk
Part-time (max 240 hours) - approx 20 hrs/wk
No Preference
Required
List Internship Goals & Objectives:
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Describe your Community Internship in DETAIL. Please be SPECIFIC when describing the scope of this request. Describe how the results of this internship will benefit health disparities and the community at large as well as the organization. What valued experiences will the student gain by participating in this internship?
Your answer
List Internship Tasks & Timelines:
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Your answer
List Internship Outcomes & Deliverables:
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Your answer
Please list any specific skills, knowledge or past experiences the student should have to be successful with this internship.
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Your answer
Please share any other information about your organization that would be useful in considering your application.
Your answer
How did you hear about our program? (Check all that apply)
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OBCED Website
CHI E-mail Notice
Brochure/Mailing
Previous CHI Intern and/or Student Consultant
E-mail notice from another organization (please name)
Referral from another organization (please name)
Other:
Required
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