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
General Information
Organization Type *
Organization Name *
Contact Person Name & Title *
Executive Director or Business Owner(s) *
Street Address (including Suite or Room #) *
City *
State *
Zip Code *
Phone *
Fax
E-mail *
Web Page
Year Established *
Number of Full-Time Employees *
Number of Part-Time Employees *
Organization Description *
Community Internships are available in the following areas. Please check the topical area(s) for which you are requesting a summer intern. *
DO NOT CHECK MORE THAN TWO CATEGORIES
Required
Do you have an MSW, MPH or equivalent on your Staff? *
Will this Internship proposal have the capability to be Remote only or a hybrid of Remote and In-Person implementation? *
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.)
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. *
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.
Required
List Internship Goals & Objectives: *
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?
List Internship Tasks & Timelines: *
List Internship Outcomes & Deliverables: *
Please list any specific skills, knowledge or past experiences the student should have to be successful with this internship. *
Please share any other information about your organization that would be useful in considering your application.
How did you hear about our program? (Check all that apply) *
Required
Next
Never submit passwords through Google Forms.
This form was created inside of University of Minnesota Twin Cities. Report Abuse