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Intern/Volunteer Application for Research Preceptorship

Instructions

Please email your resume to beth.comerford@yalegriffinprc.org and complete the form below.

Please enter your phone number with area code.

Academic Information

School/Dates Attended/Degree

Availability by Semester (hours per week)

Hours per week.
Hours per week.
Hours per week.

PRC-Related Interests

Is this to fulfill any academic requirements? Please explain.
What would make this a satisfying experience for you?
Please describe any experience you have working in a community-based setting.
Refer to http://www.griffinhealth.org/prc/ResearchFindings/CurrentCompletedProjects.aspx for description of active research studies.

Please provide three references.

Reference 1

Please provide phone number with area code.

Reference 2

Please provide phone number with area code.

Reference 3

Please enter ten-digit phone number.