Thank you for your interest in a student experience at the Fond du Lac County Health Department.  Please complete all fields below to help us understand the type of experience you are looking for.

1

Student Information:

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Student Information:

First Name

Last Name

Street Address

City

State

Phone Numberext.

Email

2

School Information:

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School Information:

Academic Institution Attending

Degree Working On/Program

Instructor's Name (If Applicable)

Instructor's Phoneext.

Instructor Email

3

Current Program Level

Current Program Level

High School

College-Associates Degree

College-Bachelors Degree

Graduate (Masters)

Doctorate

Other (Please Specify) If other, type text here.

4

Student Experience Information

Please indicate the program areas that you are interested in from the choices below. 
Maternal Child Health
Nutrition
Emergency Preparedness
Inspection
Oral Health
Communicable Diseases/Immunizations
Health Education
Tobacco Control

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Student Experience Information Please indicate the program areas that you are interested in from the choices below. Maternal Child Health Nutrition Emergency Preparedness Inspection Oral Health Communicable Diseases/Immunizations Health Education Tobacco Control

Indicate choices here:

Total Number of Hours Desired

Anticipated Start Date

Anticipated End Date

I am interested in this opportunity because (i.e., what you hope to gain)

I am a great candidate for this opportunity because (i.e., knowledge, skills, experience)

Current Degrees/Licensures (mark N/A if none:

5

Thank you for completing the application.  We may also request a resume or course syllabus at a later date. We'll be in touch within 2-3 working days.

1. To receive a copy of your submission, please fill out your email address below and submit.
2. Email Address

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