UAB School of Public Health Internship Program by a6gn01


									                                  Intern Request Form
The following information will be used to identify qualified students for an internship with
your organization.

Contact information for organization (include organization name, contact person and all
contact information:

Number of internship positions available:

Students should apply by: ___mail ___email

Brief description of company/organization/agency mission, goals, and activities:

Scope of internship work: include objectives in competency, skill, knowledge or
understanding of public health principles:

To meet the above described objectives, the student shall conduct the following activities:

Special qualifications desired of the intern:

Reporting requirements:

Period of Performance:       ___ Fall semester ___ Spring semester ___ Summer semester

Is a salary available?       ___ Yes ___ No        If yes, amount: ________________

                            Please return the completed form to:

                           Joan Ohrn, Director of External Relations
                                UAB School of Public Health
                                  1665 University Boulevard
                                 Birmingham AL 35294-0022


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