Field Placement Site Application

    * Required Field  
   
Name of Organization:*
   
Type of Organization:*
   
Address:*
 
 
   
Phone:*
   
Fax:
   
Email:*
   
Agency Website:
   
How many students can your organization accept at one time?
   
May prospective interns contact you directly? Yes             No
   
Preceptor Name:*
   
Preceptor Title:*
   Preceptors must have substantial experience in public health or a related field.  Please email a copy of your resume/CV to the Program Coordinator at mph@mcw.edu
   
Anticipated Start and End Dates
   
Is your agency able to offer a stipend or other financial compensation for the student? Yes             No
   
If yes, provide an estimate of monetary or other form of compensation.
   
Please provide a brief description of the types of public health projects or activities in which you envision the student being involved.

 
Please list minimum qualifications (experience, computer skills, languages spoken, etc.) you require of the student.
 
If possible, please send any brochures or materials that would be useful in describing your organization to students and Faculty Advisors.
     MPH Program
     Institute for Health and Society
     Medical College of Wisconsin
     8701 Watertown Plank Road
     Milwaukee, WI 53226
 
Phone:  414-955-4510
Fax:  414-955-6529
Email:  mph@mcw.edu

 

Medical College of Wisconsin
8701 Watertown Plank Road
Milwaukee, WI 53226
(414) 955-8296
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Page Updated 10/23/2014
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