Copy of MHHD Health Equity Internship Application Survey

Question Title

* Name and Contact Information

Name *

Address *

Address 2

City *

State *

ZIP *

Email *

Phone *

Question Title

* MHHD’s office is located at 201 West Preston Street, Baltimore, MD 21201.
For the duration of the internship, will you be able to work onsite?

Yes

Question Title

* Academic Information

College/University

City

State

Dates Attended

Graduation Date

Major

GPA

Question Title

* Degree level

Bachelor's

Master's

Doctorate

Other (please specify)

Question Title

* Applying for:

Summer 2022 (July - September)

Question Title

* Statement of Intent: Please upload a statement of your interest in and goals for an internship placement with the Office of Minority Health and Health Disparities.
Statement should be no longer than one page. (Only PDF, DOC, and DOCX files are accepted.)

File name must be: FirstName_LastName_Statement

PDF, DOC, DOCX file types only.

Choose File

Question Title

* Will your internship be:

Independent (internship hours will NOT count towards course credit)

University affiliated (internship hours WILL county towards course credit)

Question Title

* If university affiliated, upload the internship placement site requirements and agreements (only PDF, DOC, and DOCX files are accepted).

File name must be: FirstName_LastName_Requirements

PDF, DOC, DOCX file types only.

Choose File

Question Title

* How many hours do you want to work, per week?

Question Title

* What days are you available to work?

Monday

Tuesday

Wednesday

Thursday

Friday

Question Title

* If you are fluent in any languages besides English, please indicate.

Language 1

Language 2

Language 3

Language 4

Question Title

* Please indicate your level of experience for each of the following software applications.

	No experience	Beginner	Intermediate	Proficient
SAS	SAS No experience	SAS Beginner	SAS Intermediate	SAS Proficient
SPSS	SPSS No experience	SPSS Beginner	SPSS Intermediate	SPSS Proficient
MS Access	MS Access No experience	MS Access Beginner	MS Access Intermediate	MS Access Proficient
MS Excel	MS Excel No experience	MS Excel Beginner	MS Excel Intermediate	MS Excel Proficient
MS PowerPoint	MS PowerPoint No experience	MS PowerPoint Beginner	MS PowerPoint Intermediate	MS PowerPoint Proficient
MS Word	MS Word No experience	MS Word Beginner	MS Word Intermediate	MS Word Proficient
GIS	GIS No experience	GIS Beginner	GIS Intermediate	GIS Proficient

Other (please specify)

Question Title

* Please select all areas of interest you would be willing to accept internship placement and project assignment.

Grant management

Technical assistance

Community-based organizations

Racial/ethnic data

Health equity training

Cultural, linguistic, and health literacy training

Health policy

Workforce development and training

Other (please specify)

Question Title

* How did you hear about MHHD and the Health Equity Internship program?

Question Title

* Upload your resume (only PDF, DOC, and DOCX files are accepted).

File name must be: FirstName_LastName_Resume

PDF, DOC, DOCX file types only.

Choose File

The questions below ask demographic information for reporting purposes only and will not be used in evaluation of your application. These questions are optional.
You have to scroll through them, though, to get to the 'submit' button.

Question Title

* Preferred pronouns

He/him/his

She/her/hers

They/them/theirs

Prefer to not answer

Other (please specify)

Question Title

* Age Group

Under 18

18-24

25-34

35-44

45-54

55-64

65+

Question Title

* Race

White or Caucasian

Black or African American

Asian or Asian American

American Indian or Alaska Native

Native Hawaiian or other Pacific Islander

Prefer to not answer

Other (please specify)

Question Title

* Are you Hispanic?

Yes

Prefer to not answer

Question Title

* What is your ancestry or ethnic origin? (E.g., Italian, Japanese, Cambodian, Nigerian, etc.)

Question Title

* Submit application

I attest that the information in this application is true and accurate to the best of my knowledge.

You are ready to submit your application. Please review to ensure that all required answers are answered.

Copy of MHHD Health Equity Internship Application

Question Title

* Name and Contact Information

Question Title

* MHHD’s office is located at 201 West Preston Street, Baltimore, MD 21201. For the duration of the internship, will you be able to work onsite?

Question Title

* Academic Information

Question Title

* Degree level

Question Title

* Applying for:

Question Title

* Statement of Intent: Please upload a statement of your interest in and goals for an internship placement with the Office of Minority Health and Health Disparities.Statement should be no longer than one page. (Only PDF, DOC, and DOCX files are accepted.)

Question Title

* Will your internship be:

Question Title

* If university affiliated, upload the internship placement site requirements and agreements (only PDF, DOC, and DOCX files are accepted).

Question Title

* How many hours do you want to work, per week?

Question Title

* What days are you available to work?

Question Title

* If you are fluent in any languages besides English, please indicate.

Question Title

* Please indicate your level of experience for each of the following software applications.

Question Title

* Please select all areas of interest you would be willing to accept internship placement and project assignment.

Question Title

* How did you hear about MHHD and the Health Equity Internship program?

Question Title

* Upload your resume (only PDF, DOC, and DOCX files are accepted).

Question Title

* Preferred pronouns

Question Title

* Age Group

Question Title

* Race

Question Title

* Are you Hispanic?

Question Title

* What is your ancestry or ethnic origin? (E.g., Italian, Japanese, Cambodian, Nigerian, etc.)

Question Title

* Submit application

* MHHD’s office is located at 201 West Preston Street, Baltimore, MD 21201.
For the duration of the internship, will you be able to work onsite?

* Statement of Intent: Please upload a statement of your interest in and goals for an internship placement with the Office of Minority Health and Health Disparities.
Statement should be no longer than one page. (Only PDF, DOC, and DOCX files are accepted.)