Student and Intern Form

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Please fill this form out if you are interested in volunteering with WCHD as a student or intern placement.

First and Last Name *

Email *

Phone *

Use this format: (920) 555-1234

Preferred communication method *

Text

Phone

Other:

Current address *

Street, City, Zip

Do you have access to a vehicle? *

Yes

Other:

Do you have access to a computer/laptop? *

Yes

Other:

Student level *

High school

College Sophomore

College Junior

College Senior

Post-baccalaureate

Accelerated

Other:

School *

UW Oshkosh

UW Green Bay

UW Madison

Fox Valley Technical College

Other:

Program / Major (if applicable)

Instructor Name *

Instructor Email *

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