The Center for Health Improvement Internship Application

Have Questions? Please contact Kelly:

kelly.flaska@haysmed.com
Phone: 785-623-6324

Internship Deadlines:

Spring Term – October 1
Summer Term – March 1
Fall Term – June 1

Your Name (required)

Your Email (required)

Your Phone Number (required)

Address

Date of Birth (MM/DD/YYYY)

Applying for Internship during following semester

Credit Hours Needed

Emergency Contact Name & Number

College(s) Attended

Hometown

Degree Seeking or Obtained
Degree SeekingObtained Degree

Emphasis

Date Graduated or Expected Completion Date (MM/DD/YYYY)

Nickname

Applicable Certifications (ACSM, NASM, CSCS, etc)

Goals (Personal & Professional)

Interests

Shirt Size
SMLXLXXL