Community Health Initiative (CHI) Internship Application (Organization Form)

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INCOMPLETE APPLICATIONS AND THOSE ORGANIZATIONS NOT MEETING THE PROGRAM REQUIREMENTS WILL NOT BE CONSIDERED. FOR MORE INFORMATION, PLEASE GO TO THE CHI WEBSITE: https://bced.umn.edu/CHI/Internship

General Information

Organization Type *

Nonprofit

Business

Organization Name *

Contact Person Name & Title *

Executive Director or Business Owner(s) *

Street Address (including Suite or Room #) *

City *

State *

Zip Code *

Phone *

Fax

E-mail *

Web Page

Year Established *

Number of Full-Time Employees *

Number of Part-Time Employees *

Organization Description *

Community Internships are available in the following areas. Please check the topical area(s) for which you are requesting a summer intern. *

DO NOT CHECK MORE THAN TWO CATEGORIES

Public Health

Community Health Education

Social Work

Population Health Coordination

Nursing Care/Management

Health/Medical Research

Feasibility Study

Program Evaluation/Measurement

Program Development

Community Outreach

Communications/Event Planning

Other:

Required

Do you have an MSW, MPH or equivalent on your Staff? *

Yes

Will this Internship proposal have the capability to be Remote only or a hybrid of Remote and In-Person implementation? *

Yes

If you are interested in working with a particular student, please provide their name and e-mail address. (NOTE: the Student must also apply and request you for their Internship Organization.)

Internships can be full-time (40 hrs/wk), 3/4 -time (30 hrs/wk) or part-time (20 hrs/wk). Please indicate your preference. Do NOT select more than two options. *

NOTE: Total number of hours below are based on a 12-week timeframe. Although the duration of the internships is from the end of May to August (approximately 14 weeks), internships can start and end anytime within this period.

Full-time (max 480 hours) - approx 40 hrs/wk

3/4-time (max 360 hours) - approx 30 hrs/wk

Part-time (max 240 hours) - approx 20 hrs/wk

No Preference

Required

List Internship Goals & Objectives: *

Describe your Community Internship in DETAIL. Please be SPECIFIC when describing the scope of this request. Describe how the results of this internship will benefit health disparities and the community at large as well as the organization. What valued experiences will the student gain by participating in this internship?

List Internship Tasks & Timelines: *

List Internship Outcomes & Deliverables: *

Please list any specific skills, knowledge or past experiences the student should have to be successful with this internship. *

Please share any other information about your organization that would be useful in considering your application.

How did you hear about our program? (Check all that apply) *

OBCED Website

CHI E-mail Notice

Brochure/Mailing

Previous CHI Intern and/or Student Consultant

E-mail notice from another organization (please name)

Referral from another organization (please name)

Other:

Required

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