Internship Application Form
First name *
Your answer
Last name *
Your answer
Name (As it should appear on the internship certificate) *
Your answer
Sex *
Address (where we can send institutional communication) *
Your answer
Current city *
Indicate the city that you are currently living in
Your answer
Phone number *
Your answer
Email address *
Your answer
Basic Degree (UG Degree) *
Your answer
Highest degree awarded or working towards *
Your answer
Name of the college *
Also indicate the city in which the collage is located
Your answer
Area of interest in public health *
Your answer
Anticipated completion date of the current course( if still pursuing)
MM
/
DD
/
YYYY
Anticipated date of joining internship at IPH *
Kindly note that this is subject to vacancy at IPH and minimum duration of 2 months is compulsory
MM
/
DD
/
YYYY
Estimated duration of internship *
Please note that 2 months of internship is mandatory
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