Student Application - Children's Health Alliance of Wisconsin

Student Application Information

Welcome to our Children's Health Alliance of Wisconsin Student Application. Please be aware that once a student is selected and the follow-up paperwork is completed and submitted, the processing can take up to two months for various background and child protection checks. This paperwork is required before a student an start working at the Alliance. Since this paperwork process is legally required and bears a cost to the organization, we are looking for serious students able to commit full-time hours for a full semester, summer or year stint.

Name *

Email *

Phone *

Current Address *

Country

City

State

Zip code

Permanent Address (If different from current address; e.g. parent's address)

Country

City

State

Zip code

School Information

Name of school *

Name of program *

Anticipated degree *

Anticipated date of graduation *

Is this experience (internship, practicum, capstone, etc.) a requirement for graduation? *

Yes

Advisor name and contact information

Advisor name *

Advisor address *

Country

City

State

Zip code

Advisor email *

Advisor phone number *

Requested start date, end date and hours per week

Start date *

End date *

Number of hours per week *

Area(s) of interest

What experience are you hoping to gain (e.g. needs assessment, program implementation, partnerships)? *

Why are you interested in completing an internship with Children's Health Alliance of Wisconsin? *