Field Placement Site Application

    * Required Field  
Name of Organization:*
Type of Organization:*
Agency Website:
How many students can your organization accept at one time?
May prospective interns contact you directly? Yes             No
Preceptor Name:*
Preceptor Title:*
   Preceptors must have substantial experience in public health or a related field.  Please email a copy of your resume/CV to the Program Coordinator at
Anticipated Start and End Dates
Is your agency able to offer a stipend or other financial compensation for the student? Yes             No
If yes, provide an estimate of monetary or other form of compensation.
Please provide a brief description of the types of public health projects or activities in which you envision the student being involved.

Please list minimum qualifications (experience, computer skills, languages spoken, etc.) you require of the student.
If possible, please send any brochures or materials that would be useful in describing your organization to students and Faculty Advisors.
     MPH Program
     Institute for Health and Society
     Medical College of Wisconsin
     8701 Watertown Plank Road
     Milwaukee, WI 53226
(414) 955-4510
(414) 955-6529 (fax)