Health Disparities Research Training Program (HDRTP) Application ...

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Health Disparities Research Training Program (HDRTP) Application. Name: ... Internship program):. 1. Organization: ... I
Health Disparities Research Training Program (HDRTP) Application Name: ________________________________________________________________________________________________ Address: _____________________________________________________________________________________________ Street Apt# City/State/Zip Phone: (

) ____________-_____________________

E-mail: _______________________________________________________________________

Education (start with most recent): 1. College/University: ________________________________________________________________________ Program: ________________________________________ Expected Graduation: ________________ MM/YY

Concentration: ______________________________________________________________________________ 2. College/University: ________________________________________________________________________ Program: _____________________________________________ Graduation Date: ________________ MM/YY

Concentration: ______________________________________________________________________________ 3. College/University: ________________________________________________________________________ Program: _____________________________________________ Graduation Date: ________________ MM/YY

Concentration: ______________________________________________________________________________

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Previous Experience (list only experiences that you believe are applicable to the Internship program):

1. Organization: _______________________________________________________________________________ Title: ___________________________________________________ Dates Employed: ________________ MM/YY

Responsibilities:

2. Organization: _______________________________________________________________________________ Title: ___________________________________________________ Dates Employed: ________________ MM/YY

Responsibilities:

3. Organization: _______________________________________________________________________________ Title: ___________________________________________________ Dates Employed: ________________ MM/YY

Responsibilities:

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Internship Program Application

Please describe why you are interested in interning with the NYU-CUNY PRC and CSAAH, and how your experiences relate to its work:

Language Skills: Please list the languages you know and indicate your level of proficiency. Language

Read

Write

Speak

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Beginner Intermediate Proficient Beginner Intermediate Proficient Beginner Intermediate Proficient Beginner Intermediate Proficient

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Beginner Intermediate Proficient Beginner Intermediate Proficient Beginner Intermediate Proficient Beginner Intermediate Proficient

Beginner Intermediate Proficient Beginner Intermediate Proficient Beginner Intermediate Proficient Beginner Intermediate Proficient

Software: Please list the software programs you know and indicate your level of proficiency (ex. SPSS, Access, Adobe InDesign, EndNote). Software

Proficiency

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Beginner Intermediate Proficient Beginner Intermediate Proficient Beginner Intermediate Proficient Beginner Intermediate Proficient Beginner Intermediate Proficient Beginner Intermediate Proficient Beginner Intermediate Proficient

Rank the available internship opportunities or research area interests from 1 to 5 (1 = most interested, 5 = least interested). Descriptions are available on our website: http://bit.ly/csaah-studentinternships

1. _____________________________________________________________________________________________ 2. _____________________________________________________________________________________________ 3. _____________________________________________________________________________________________ 4. _____________________________________________________________________________________________ 5. _____________________________________________________________________________________________

Please send completed application, along with your resume and cover letter, to: Lynna Zhong Research Data Associate Phone: 646-501-2745 Fax: 212-263-4086 Email: [email protected]

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