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
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
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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