OMHPHP Internship Information Form
Please complete this form to give us a few more details about what type of experience you'd like.
* Required
First Name
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Last Name
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When would you like to begin your internship?
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Please include the month and year
When would you like to end your internship?
Please include the month and year
Do you have a preferred schedule or any scheduling restrictions?
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Include information about days and times that you would like to work and if you can work onsite or prefer to work from another location.
What are your areas of interest? What type of experience would you like to have with our office?
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Please review our website and include any projects listed that peak your interest. (http://www.vdh.state.va.us/healthpolicy/internship-opportunities.htm)
In which of the following areas do you have skills or experience
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Data Analysis
Marketing
Program Planning
Research
Survey Development
Other:
Are you seeking this internship as part of a course or on your own?
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I have to fulfull internship requirements as part of a course at my college/university
On my own - I won't receive credit from my college/university
Please answer the following questions if you are seeking an internship as part of a course.
What is the name of the course?
How many hours do you need to have?
What type of compensation are you receiving from your college/university?
Course Credit
Money
None
Other:
What is your internship coordinator's name and email address?