Summer Externship Application: Peekskill 2012

Application Deadline: March 1, 2012. (Open to UW medical students only.)

Please respond briefly to all of the following questions.

Section One: Applicant Information

Name: *

Phone Number:

E-mail Address: *

School Street Address:

School City:

School State:

School Zip Code:

School Country:

Home Street Address:

Home City:

Home State:

Home Zip Code:

Home Country:

Section Two: Planning Information

1. It's imperative that you have your own transportation. Will this be a problem?:

2. Please indicate if there are specific populations/areas you are interested in working in.:

3. Do you speak Spanish?:

4. If yes, would you like the opportunity to use your Spanish this summer?:

5. How many weeks, and during which summer months, would you like to do this externship?:

6. Any special requests or anything we might need to know in planning your experience?:

Section Three: Questions

1. Why are you interested in the Peekskill Summer Externship?:

2. How do you define community health?:

3. What do you hope to learn from this experience about providing and promoting community health?:

4. How will you use what you learn after the experience?:

5. How do you believe your personal qualities will complement the community health focus of this experience?:

Updated: February 08, 2012 by admin

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