School of Public Health and Health Services | George Washington University

Practicum Application - Student

* indicates a required field.

Student Information

First Name: *

Last Name: *

Gwid: *

Phone Number (Daytime): *

Phone Number (Evening): *

Email Address: *

(An @gwu.edu or @gwmail.gwu.edu address is required.)

Confirm Email Address: *

Anticipated Graduation: * /

Department/Track: *

Years of relevant public health experience:

I am a U.S. Citizen

If not, please indicate:

Your country of residence:

What is your visa status?

What country is your visa from?

Practicum Information

Practicum Status: *

When are you available to be on-site?

Start Date: * /

End Date: * /

Which of the following describes the organizations that you are interested in? (Check all that apply)

If you would like to do your practicum in an international location, please specify country/countries: