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KRDHD Student Practicum Application

We appreciate your interest in doing a practicum at the Kentucky River District Health Department. To help us understand your practicum needs we request you complete the following student application. We will review your application and be in contact with a determination regarding availability and opportunities.

1) Full Name *

2) Home county/state *

3) Email *

4) University/College *

5) College/Department *

6) Semester Practicum Begins *Fall (Aug-Dec)Spring (Jan-May)Summer (May-July)Other

If Other, please write in:

7) Area of Interest (check all that apply) *AdministrativeHarm Reduction/Substance Use DisorderHealth PromotionHANDSBreastfeeding ProgramEnvironmentalFamily PlanningOther - Write In (Required):

8) Days of the week and hours student would have available to complete practicum hours? * *

9) Total Number of Hours Required* *

10) Is there an academic assignment required with your placement (i.e. research project, capstone project) that requires access to specific agency material or client interaction? *

11) If assignment is required, provide details about what is required. *

12) What skills. knowledge or program competencies do you hope to gain by completing a practicum with the KRDHD? *

13) What skills would you bring to the practicum site? (i.e. Word, Excel, PowerPoint, Canva, organizational skills, data collection and analysis) *

14) Requirements of practicum supervisor (education/experience). *

15) Is there a current MOU or Affiliation agreement between your university/college and the KRDHD? *YesNoUnsure, but will check status

16) Other information you would like us to consider in your request. *

ADDRESS:

441 Gorman Hollow Rd.
Hazard, KY 41701
 (606) 439-2361
 (606) 439-0870

MEET US HERE!

NOTICE OF PRIVACY PRACTICES

KRDHD does not exclude people or treat them differently because of race, color, national origin, age, disability, or sex (including pregnancy, sexual orientation, and gender identity).

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