Nurse Anesthesia Internship Application

Please complete all fields. 

 Full Name:
 Street Address:
 City:
 State:
 Zip Code:
 Phone (primary):
Phone (second, optional):
Email Address:
College/University:
Major course of study:
Year in educational program:
   
Your specific goals for participation in this internship (what do you hope to gain?)
Particular interests (internet, audio-video production, education, development of teaching materials, statistics tracking/analysis, medical/nursing science, etc.)

   
 Internships include varying amounts of time spent in office activities and in observation in the clinical area. Indicate your preference for participation in the following activities: 

Administrative work (filing, sorting, typing, gathering statitstics, etc.)

   
  
   

Clinical observation

  
  
   

Computer/multimedia (web site, power point, video production)

  
  
   
Indicate the number of hours per week you would like to serve in the internship.

Indicate which days of the week you would like to serve in the internship.

  
   
What time of day are you available?
   
Indicate your desired start date.  Tuesday, June 01, 2010 Select a Date Delete the Date
Indicate your desired end date.  Friday, August 20, 2010 Select a Date Delete the Date
           
  

Quick Reference

Nurse Anesthesia Program

(T) 336-716-1411
(F) 336-716-1412

Email:
napinfo@wakehealth.edu

Hours
7:30 am - 4:00 pm
Mailing Address 
Wake Forest Baptist Health
Nurse Anesthesia Program
3rd Floor PCU
Medical Center Blvd
Winston Salem, NC 27157  

        

Ways to Give
USNWR 2013-2014Magnet Hospital RecognitionConsumer Choice2014 Best DoctorsJoint Commission Report

Disclaimer: The information on this website is for general informational purposes only and SHOULD NOT be relied upon as a substitute for sound professional medical advice, evaluation or care from your physician or other qualified health care provider.