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MPH Practicum Application
MPH Student Practicum Application

Date of Application (MM/DD/YYYY)
Full Name
Current Address
Permanent Address
Email Address
Phone Number (Home) including area code
Phone Number (Cell) including area code:
Please indicate desired internship session.

Please indicate the specific position for which you are applying (if any).
What are your desired start and end dates for this internship?
Would your commitments outside of the internship offer enough flexibility to accommodate small changes (for instance working different hours during a week when a supervisor is out)
How did you hear about Case Western Reserve University's Prevention Research Center for Healthy Neighborhoods (PRCHN)?
Is this internship required to fulfill an academic obligation?
What do you hope to gain from this internship?
Cleveland is an urban area with several low-income neighborhoods. This job may require you to be out in those areas and interacting with neighborhood residents. Do you feel comfortable with this?
Do you currently hold a valid driver's license?
The PRCHN and Case Western Reserve University value diversity. Are you comfortable working with diverse populations?
What are your internship interests?
Have you had an internship before?
Please check your level of experience in using SPSS:

Please check your level of experience in using SAS:

Please check your level of experience in using r software.

Have you had experience with:

Have you completed a training course in human subjects in research?
If "Yes," what is the name of the course? At which institution did you complete the course? If "No," successful completion of a training course for human subjects in research is required prior to starting a PRCHN internship. An online course can be completed free of charge through Case Western Reserve University. Not having completed the course prior to application for the internship does not disqualify your application.
Current or most recent university; include name, city and state. (School and GPA required of all students.)
Expected Graduation Date
Degree and major (include minor if applicable).
GPA (if applicable)
Please list chronologically other colleges or universities you have attended, dates attended, and grade point average.
School: City, State: Dates Attended: Major/Minor: GPA
School: City, State: Dates Attended: Major/Minor: GPA
List any scholastic honors and/or licenses.
Please provide TWO references (one of which must be an academic reference). Please provide a phone number, relationship to you, and email address.
After you click "submit," please complete your application by uploading the following documents as PDF files: 1) A copy of your current resume or CV; 2) A one-page essay indicating why you are interested in a PRCHN Internship, your long-term career interests, and what you hope to achieve during the internship; and 3) A copy of your human subjects research training certificate of completion.
Your Name:
Your Email:

To validate your submission, please answer the following math problem:

9 + 4 =