EmailMe Form - Internship Application

Name

First Last

I am a(n): *

Undergraduate Senior

Graduate Student

Department:
(For Undergraduate Seniors)

Communication Disorders

Kinesiology

Nutrition

Public Health Sciences

Department:
(For Graduate Students)

I'd like to work in: *

Holyoke

Springfield

Pittsfield

Other Berkshire County community

Check all that apply

I am available to work: *

10 hours/week

20 hours/week

30 hours/week

40 hours/week

Check all that apply

Do you have your own form of transportation?: *

Yes

No

There is public transportation to Holyoke, some to Springfield and very little to the Berkshires. Most projects will require some, if not all hours to be completed on site.

How can you best be reached? *

Mail, Phone, or Email

Address

Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country

Phone

### - ### - ####

Email *

What kinds of things would you like to learn from your internship? What populations, topics, skills are you interested in if you got to choose? *

Do you have any of the following skills?: *

Are there any restrictions to your availability?

For example: can't work Wednesday's, not free after 3pm, etc.

Are you fluent in any language other than English? *

Yes

No

Which language?

Please upload your resume here: *

pdf, doc, or docx