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S2jgDYYAorMa5S2aL9wPJ8FrcVqmKGHxhYCoATtEjiVdd939rWmAVqAP9NiWmAPuhmUq4zZmpccIEPrhXiP7DBvr5x4M9UDt9jIWccLawTEpzz6J

Public Health Internship Program Application Form 2023

Please complete the survey below.

Thank you!

Thank you for your interest in the Mount Sinai Public Health Internship Program. Please fill out the questionnaire below and press "Submit" at the bottom of the page in order to apply.

You will also be asked attach the following documents to complete your application:

1. 1-page personal statement describing how this program will enhance your career, including a description of your current research interests and professional goals after completing the program.

2. 1-page statement on your past research experience, describing the subject of research projects, dates conducted and your role and duties.

3. Most recent CV/resume.

In addition, you will be asked to provide contact information for two (2) persons who can serve as your reference.

If you have any questions, please contact us at healthinternship@mssm.edu.

First Name

* must provide value

Last Name

* must provide value

Date of Birth

* must provide value

M-D-Y

Phone Number

* must provide value

Email Address

* must provide value

Secondary Email Address

Street Address

* must provide value

Street Address 2

City

* must provide value

State

* must provide value

Country

* must provide value

Zip Code

* must provide value

WEB PAGE OR LINKEDIN URL (if applicable):

Residency Status

* must provide value

US Citizen

Non-Citizen National

Permanent Resident

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Race/Ethnicity (Check all that apply)

* must provide value

African American

Hispanic American

Native American

Hawaiian Native

Native Pacific Islander

Asian American

White

Do you have physical or mental impairment that substantially limits one or more major life activities?

* must provide value

Yes

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Do you or your family receive one or more of the following? (Check all that apply)

* must provide value

Federal disadvantaged assistance

Health Professions Student Loans

Loans for Disadvantaged Students Program

Scholarships for Individuals with Exceptional Financial Need (USDHHS)

Earliest possible start date

M-D-Y

How long will you be able to commit to this program?

Name of School Attended

* must provide value

Degree (BA, MPH, etc.)

* must provide value

Date Awarded or Expected

* must provide value

M-D-Y

Area(s) of Study

* must provide value

Is your current or final cumulative GPA from this school 3.0 or higher?

* must provide value

Yes

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Have you attended any additional schools?

* must provide value

Yes

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Name of School Attended

* must provide value

Degree (BA, MPH, etc.)

* must provide value

Date Awarded or Expected

* must provide value

M-D-Y

Area(s) of Study

* must provide value

Have you attended any additional schools?

* must provide value

Yes

reset

Name of School Attended

* must provide value

Degree (BA, MPH, etc.)

* must provide value

Date Awarded or Expected

* must provide value

M-D-Y

Area(s) of Study

* must provide value

Have you presented (poster or oral) at professional conference(s)?

* must provide value

Yes

reset

Name of Conference

Title of Work Presented

* must provide value

Expand

Do you have additional conference presentations to add?

* must provide value

Yes

reset

Name of Conference

Title of Work Presented

* must provide value

Expand

Do you have additional conference presentations to add?

* must provide value

Yes

reset

Name of Conference

Title of Work Presented

* must provide value

Expand

Do you have additional conference presentations to add?

* must provide value

Yes

reset

Name of Conference

Title of Work Presented

* must provide value

Expand

Please provide a brief list of your research areas of interest

* must provide value

Expand

Please provide a list of publications you have authored

* must provide value

Expand

Please provide a list of your research skills (ie. PRC, statistical programs, scientific writing, microscopy, clinical training, etc.)

* must provide value

Expand

Please attach your personal statement (maximum 1 page), describing how this internship program will enhance your career. Include a description of your current research interests and professional goals after completing this program.

***Please type your name at the top of the page. Only PDF files are accepted.***

* must provide value

Upload file

Please attached your statement on your past research experience (maximum 1 page), describing the subject of the research projects, dates conducted and your role and duties.

***Please type your name at the top of the page. Only PDF files are accepted***

* must provide value

Upload file

Please attach your most recent CV/resume.

***PDF file only***

* must provide value

Upload file

Name

* must provide value

Institution

* must provide value

Title

* must provide value

Phone Number

* must provide value

Email Address

* must provide value

Name

* must provide value

Institution

* must provide value

Title

* must provide value

Phone Number

* must provide value

Email Address

* must provide value

It is the policy of Mount Sinai, the Department of Environmental Medicine and Public Health, and the Division of International Health to assure that applicants are employed, and that employees are treated
during employment, without regard to their race, religion, sex, color, national origin, age or disability.
Such action shall include; employment, upgrading, demotion, or transfer; recruitment or recruitment
advertising; layoff or termination; rates of pay or other forms of compensation; and selection for
training, including apprenticeship, per-apprenticeship and/or on-the-job training.

I hereby confirm that the information provided above is true and accurate. I understand that if the statements are found to be inaccurate, the program will revoke my acceptance to the program.

* must provide value

Add signature

Date

* must provide value

M-D-Y

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