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South Central AHEC Community Health Internship Program (CHIP) Host Site Proposal
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Email
*
Your email
Which of the following counties is the host site located? If your county is not listed please return to the website and access the correct proposal:
https://ahec.wisc.edu/chip/
*
Adams
Columbia
Dane
Dodge
Green
Green Lake
Iowa
Jefferson
Lafayette
Marquette
Rock
Sauk
Waushara
Other:
Has your organization hosted a CHIP intern in the past? Please only consider if you've had a CHIP intern and not only that you applied to be a host site in the past.
*
Yes
No
Other:
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