Student Application
Please complete and submit application for the Patient Navigation Internship Program
First and Last Name *
Your answer
Email Address *
Your answer
Phone Number (xxx) xxx - xxxx *
Your answer
Undergraduate School of Attendance *
Your answer
Undergraduate Major *
Your answer
Undergraduate GPA *
Your answer
Undergraduate Graduation Year *
Your answer
Are you pursing any pre-professional programs (i.e. Pre-med, pre-dental, pre-pharm, etc) ? If yes, please describe. *
Your answer
I understand this is a voluntary UNPAID internship *
I understand this program requires a 1 year commitment *
Required
How do you plan to commute to HealthSource of Ohio clinical sites? *
Have you applied to the HSO Patient Navigation Internship in the past? If so, when? *
Your answer
Please list which HSO clinical site you would be able to travel to for your weekly assignment. *
Note that for Fall 2019 only Batavia, Mt. Orab, and New Richmond are available.
Captionless Image
How did you hear about the HSO Patient Navigation Internship Program? *
References Needed
One professional and one peer.
Professional Reference *
A professional reference is an individual who has worked with or overseen you in a professional setting (e.g. advisor, mentor, supervisor, professor, or employer that is not a family member or friend). Please include reference person's name, reference email/phone, and relationship with applicant.
Your answer
Peer Reference *
A peer reference is an individual who has known you for over three months, and has worked with you in an academic, professional, or extracurricular setting (i.e. leader of student organization, group member, fellow athlete). Please include reference person's name, reference email/phone, and relationship with applicant.
Your answer
Supplemental Materials
Please complete two essays described below, and upload your most recent resume or curriculum vitae.
Essay #1 *
Define community service. What does community service mean to you? Max 250 words.
Your answer
Essay #2 *
Essay #2: How can you help HealthSource of Ohio's Patient Navigation Internship succeed? Max 250 words.
Your answer
Email Updated Resume/CV to navigationprogram@hsohio.org
subject: [PNI Application Resume/CV 2019] - Your First and Last Name
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