Milwaukee Center for Independence: Assisting individuals with special needs
 

Internship Application

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INTERN APPLICATION

PLEASE NOTE: FIELDS MARKED WITH AN ASTERISK ARE REQUIRED.

GENERAL INFORMATION

To which agency are you applying (MCFI, Whole Health Clinical Group, SEDA, other)?*:  

Internship area of interest*:

Number of hours available per week:

Date you are available to start your internship:

PERSONAL INFORMATION

First Name*:

Middle Initial:

Last Name*

Best Phone to Reach You (With Area Code)*:

Email*:

MAILING ADDRESS

Street Address 1*:

Street Address 2:

City*:

State*:

Zip Code*:

ACADEMIC INFORMATION

College or University*:

Course Title or Area of Study*:

Number of internship hours required by course:

Name of instructor:

How were you referred to MCFI?*

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