Wisconsin Alliance for Women's Health Intern Application Form
Date of Application *
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Name *
Address *
(Street Address)
City *
Zip Code *
Preferred Phone Number *
Email Address *
Are You Over the Age of 18? *
Date of Birth *
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Age *
Race/Ethnicity (Optional)
What is Your Gender (Optional)
Emergency Contact Name *
Emergency Contact Phone Number *
When/How Long Are You Interested in Interning? *
When Would You Be Available to Start Interning
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How did you first learn of the Wisconsin Alliance for Women's Health and about the volunteer/intern opportunities? *
Please describe any general or specific skills (paid and volunteer) you feel would be helpful in your ntern work at the Wisconsin Alliance for Women's Health (e.g. customer contact, computer skills, public speaking, written communications, leadership) *
Please briefly describe your community affiliation *
What made you want to intern with the Wisconsin Alliance for Women's Health? *
In what way would you like to help contribute to the Wisconsin Alliance for Women's Health? *
What does "women's health" mean to you? *
What are your internship goals with the Wisconsin Alliance for Women's Health? *
Availability (please check all that apply) *
Required
Please note which days you'd be available to intern
Please provide a copy of your resume if available
Confidentiality *
Your intern position may expose you to confidential information and records. Under no circumstances can you reveal this information except as may be required in the course of your work or by law. WAWH will immediately terminate any volunteer/intern who breaches confidentiality about individuals we work with, intern financial or management matter, staff members, donors, or other volunteers/interns. Unauthorized use or disclosure by you or any such information constitutes a breach of promise of your intern/volunteer commitment to WAWH and may subject you to court action by any interested party and/or to other sanctions by WAWH. By initialing below, you agree to maintain the confidentiality of all information, even after your active intern/volunteer status has ended, and certify that all information provided is true and complete and authorize WAWH to verify information provided.
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