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Home > Forms > IHIP Application

Indigenous Health Internship Program (IHIP)

For privacy reasons, please do not include personal information containing diagnoses and/or treatments.

Indigenous Health Internship Program Application

Comments

This field is for validation purposes and should be left unchanged.

Which internship program are you applying for?

Adult

High School

Name

First Last

Home Phone

Work Phone

Mobile Phone

Do you have a Facebook account?

Yes

Facebook account profile

Address

Street Address Address Line 2 Town / City Province Postal Code

School / Institution

Location

Grade Level completed?

Year

How did you hear about the program?

another student

community centre

employment centre

flyer / poster

friend

Internet

newspaper

school

self-referral

workshop

other

Other (heard about program)

Employment background

Job Title

Employer

Tel

Start Date

End Date

Current cover letter and resume attached?

Yes

Cover letter and Resume upload

Accepted file types: pdf, doc, docx, rtf, txt, Max. file size: 5 MB.

Do you require any accommodations to perform job duties?

Yes

Please specify the accommodations needed

Describe your future career goals / ambitions

What type of health careers are you interested in learning about?

Southern Health-Santé Sud requests Indigenous people to self-identify by completing this voluntary self-declaration.

Treaty Status

(indicate which community you are a member of)

Inuit

Métis

Non-status

other

Community Name

(please specify)

Treaty Card #

Other treaty status

(please specify)

e-Signature

Healthier people. Healthier communities. Thriving together.

Southern Health-Santé Sud

Partnering with our communities, we provide safe, accessible and sustainable people-centred health care.