Volunteer Internship Program Application

Name *

First

Last

Email *

Phone Number *

I understand this is an unpaid position. *

Yes No

I understand that this program requires a minimum commitment of 8 hours/week for one year. *

Yes No

Do you speak another language fluently? *

Yes No

If yes, what language? *

Please provide one professional reference.

This should be an individual who has overseen you in a professional setting, such as an advisor, supervisor, professor, or employer. Do not include a relative.

Reference Name *

Relationship to Reference *

Reference Email Address *

Please provide one peer reference.

This should be a peer who you have worked with or under in a professional or extracurricular setting. Examples include a leader of a student organization, partner in a group project, or fellow student in a research lab. Do not include a relative.

Reference Name *

Relationship to Reference *

Reference Email Address *

Undergraduate School of Attendance *

Undergraduate GPA *

Undergraduate Major *

Undergraduate Graduation Year *

How did you hear about the Crossroad Volunteer Internship Program *

Graduate School of Attendance *

How do you plan to commute to Crossroad Health Center? *

Are you pursuing any of the following pre-professional programs? *

Please check which location(s) you would be able to travel to for your weekly shift. *

OTR (5 E. Liberty St, 45202) West (2859 Budinot Ave., 45238) Harrison (10450 New Haven Rd, 45030)

The supplemental materials includes three components:

Essay #1: What is your obligation to your community? 250 word maximum, single-spaced.
Essay #2: Describe a time when your perspective on an issue was challenged and how you handled it. 250 word maximum, single-spaced.
Professional Resume: 2 page maximum

Submit the supplemental materials as one PDF with the title in the format of Lastname_Firstname.pdf. *

Max file size: 20MB

It is the policy of Christian Community Health Services to ensure equal employment opportunity in accordance with the Ohio Revised Code 125.111 and all applicable federal regulations and guidelines. Employment discrimination against employees and applicants due to race, color, religion, sex, national origin, disability, age, military status, or veteran status is illegal.

Crossroad Volunteer Internship Program Online Application

Applicant Information

Please provide one professional reference.

Please provide one peer reference.

Supplemental Materials

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