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Request for Internship/Clinical Placement

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1. Student Information(current) This section is complete This section is incomplete
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3. Internship/Clinic Information This section is complete This section is incomplete

Student Information

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Email
Address 1
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School Information

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Program of Study
1. Community Health
2. Nursing
3. WIC-Nutrition
4. Other
Degree
1. Graduate
2. Undergraduate
3. RN to BSN
4. Other
Other Description
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Address1
Address2
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Internship/Clinic Information

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Is there a project requirement? If so, please describe
Additional Comments
Also email a copy of the curriculum, student evaluation form/criteria and resume to PHE@washingtoncountymn.gov.

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14949 62nd Street North
Stillwater, MN 55082-6132
Phone: 651-430-6000
Phone: 651-430-6246 (TTY)

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