Student Internship Application

Student Internship Application Form

Please complete and submit this form to request or apply for a student internship opportunity.
(If you are not submitting this form, click on the Close button.)

*Indicates Response Required

*1. Name

*2. Address 1

Address 2

*City

*State

*Zip

3. Phone Number (Including area code)

4. Cell Phone Number (Including area code)

*5. Email

*6. GSPH Division

7. Completed PH Courses

PH 601 Epidemiology
PH 602 Biostatistics
PH 603 Behavioral and Social Science in Public Health
PH 604 Environmental Determinants of Human Health
PH 605 Health Services Administration

Please list any other PH Courses that you have already completed.
(Course numbers only) Click here to view a PDF file of all PH courses.

*8. Are you interested in receiving g 650/750 credit for this internship?

*9. Faculty Adviser

10. Previous College Education

Degree	University	Major	Year Received

11. Briefly describe any past work experience that may be desirable to a public health agency.

12. Do you speak or understand any languages other than English? If so, please list each language and indicate level of fluency.

*13. Please indicate your level of experience for each of the following software applications.

	No Experience	Some	Very Experienced
SAS
SPSS
Access
Excel
GIS software
PowerPoint

*14. Over what period of time would you be available?
(e.g. Spring semester, May through August, etc.)

*15. How many hours per week would you like to devote to your internship position?

*16. Do you require a paid internship?

*17. What would you like to learn from your internship? What are your areas of interest?

*Indicates Response Required

Institute for Public Health
Graduate School of Public Health
San Diego State University

http://iph.sdsu.edu