Interest in Public Health Volunteer/Internship Opportunity

Student Interest Form

For student interests regarding volunteer and internship opportunities with Contra Costa Health Services' Public Health Department, please fill out this form to the best of your ability and upload your resume.

Volunteer and internship opportunities are not guaranteed by completing this form. If there is an opportunity available within 3 weeks of your request, we will email you at the contact listed below. If you do not receive a follow-up email within that timeframe, we unfortunately were unable to match you with an opportunity that meets your request. However, we will keep your information on file if an opportunity becomes available in the future.

Please email questions to CareerPathways@cchealth.org.

Question Title

* 1. About you

First Name

Last Name

Date of Birth (month/day/year)

Current age

Address (Street, City, State Zip Code)

Email (preferably a personal email you check often, not school-related)

Phone Number

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* 2. Indicate your race/ethnicity

White or Caucasian

Black or African American

Hispanic or Latino

Asian or Asian American

American Indian or Alaska Native

Native Hawaiian or other Pacific Islander

Other: If your race/ethnicity is not listed, or if you identify as two or more races, please indicate how you identify:

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* 3. Do you speak another language? If yes, please indicate the language and your proficiency (i.e. basic, proficient, or fluent). If no, type "N/A."

You are a first-generation college student if your parents/guardians didn't graduate high school or go to college. Even if an older sibling graduated or went to college, you are still considered a first-generation college student.

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* 4. Are you a first-generation college student?

Yes

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* 5. Current academic status

High School Student

College Student: Associate's, Bachelor's, etc.

Graduate or PhD Student

Not currently enrolled in school

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* 6. Plans after completing current degree (select ALL that apply):

Attend a four year university

Attend a junior college

Attend a trade or vocational school

Attend graduate school (eg. Master's, PhD, M.D., etc.)

Obtain a job

I'm not sure

Other (please specify)

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* 7. Please indicate total family income

Less than $20,000

$20,000 - $39,999

$40,000 - $59,999

$60,000 - $79,999

$80,000 - $89,999

$90,000 or Greater

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* 8. Would you like to be added to our newsletter for future updates on local health resources & opportunities (i.e. jobs, internships, etc.)? Emails are sent 1-4 times a month from CareerPathways@cchealth.org or PublicHealthSolutions.info@gmail.com.

Yes

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* 9. How did you hear about this program/opportunity?

Friend/Family

Career Pathways Chronicle Newsletter

Contra Costa Health Services Website

Social Media

DVC START Program

Career Fair

Other (please specify)