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Northern Kentucky Public Health Institute: Student Learning Interest Form

If you are a student interested in a learning experience with the Health Department, please complete the following form. Questions about learning opportunities required for your degree or the application process should be directed to Louise Kent.

* Please email your resume and syllabus (or other college document with required learning objectives) to Stephanie Haggard.

Student Information:

Faculty Advisor/University Contact Information:

Academic Information:

 (Example: College of Health Sciences)

Is an internship, service learning experience, observation or rotation required for your degree?

Please select the type of learning experience for which you are applying:

(Internship, observation, etc.)
(Internship, observation, etc.)
(Please select one.)


* 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):
(Internship, observation, etc.)

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