2024-2025 Practicum Interests Form | Health Sciences Clinical Education

Name*

First Last

Email*

Are you an international student with F-1 status?*

Yes
No

Which semester do you plan to complete the practicum?*

In-person, remote, or hybrid practicum?*

Please let us know if you plan to complete the practicum in-person in the Boston area, in-person but in another city, hybrid (with some in-person contact), or fully remotely (online and no in-person contact)

Are you interested in the Global/Public Health Practicum or Clinical Practicum Track?

Please select ONE. There are two different practicum tracks. Global/Public Health Track (Professors Brown or Klufts): Health Administration and Management, Research in Public Health, Human Rights, Maternal and Child Health, Social Determinants of Health, Epidemiology, Advocacy, Health Policy, Data Analysis, Environmental Health Clinical Track (Professor Pesanelli): Clinical Experience, interested in gaining experience and applying for the following programs within a few years of graduation: MD, RN, PA, PT, OT, NP, DO, DDS

Identify your areas of interest: (Select up to 4)*

Are you fluent in any other languages besides English? If yes, please list the language(s) below.

General Career Interests. Briefly explain your career interests.*

Availability: Please indicate the days and times that you are available (Monday-Friday between 7:00am and 5:00pm) to be onsite.