Internship Application Form

The Art of Palliative Care

Please fill out the form below to apply for the internship program.

Pre-Internship Requirements

Before beginning your internship, you must complete the following:

Live Scan
TB Test
First Aid Certification
CPR Certification

These requirements are essential to ensure your preparedness and compliance with agency standards. Please ensure all certifications and tests are completed prior to your start date.

Personal Information:

First name

Last name

Birthday

Month

Day

Year

Gender

Female

Male

Contact Number:

Email:

Current Address:

Permanent Address (if different from current address):

Emergency Contact Name and Number:

Academic Information:

Current Educational Institution:

Degree Program:

Year of Study:

Expected Graduation Date:

Relevant Courses Completed:

Academic Advisor’s Name and Contact Information:

Internship Details:

Why are you interested in the Art of Palliative Care internship?

What skills or experiences do you hope to gain from this internship?

Are there specific areas of palliative care you are particularly interested in?

Availability:

Start Date:

End Date:

Hours per week:

References:

Reference 1 Name:

Relationship to Applicant:

Contact Information:

Reference 2 Name:

Relationship to Applicant:

Contact Information:

Additional Information:

Please provide any additional information or documents you feel are relevant to your application. Attach and send them to intake@artofpalliativecare.net.

Resume

Cover Letter

Letters of Recommendation

Portfolio (if applicable)

Other:

I hereby declare that the information provided in this form is true and accurate to the best of my knowledge.

I agree

Signature

Date:

Month

Day

Year