Wood County Student Experience Application

Address

Academic Institution Attending

Degree Working On/Program

Current Program Level High School
College - Associates Degree
College - Bachelors Degree
Graduate (Masters)
Doctorate
Other (specify below)

Other Program (optional)

Semesters Completed

Instructor's Name

Instructor's Phone

Instructor's E-Mail

Type of Learning Experience (please indicate top three choices): Family Health Injury Prevention (Maternal Child Health)
Breastfeeding Services
Community Health Planning
Emergency Preparedness
Leadership and Management
Nutrition Services/WIC
Environmental Health
Oral Health
Communicable Diseases/ Immunizations
Health Education/Promotion
Other (specify below)

Other Experience Choice (optional)

Total Number of Hours Required

Anticipated Start Date

Anticipated End Date

I am interested in this opportunity because (i.e., what I hope to gain):

I am a great candidate for this opportunity because (i.e. knowledge, skills, experience):

Current Degrees/Licensures (mark "N/A" if none)

Your Résumé

Class Syllabus

Wood County, Wisconsin

Wood County Student Experience Application

Student Information

School Information

Student Experience Information

Attachments