1. Contact Information

   *Name
   *Street Address
   Address (cont.)
   City
   State
   Zip/Postal Code
   *Home/Cell Phone
   Work Phone
   *E-mail

2. Are there specific volunteer or internship opportunities that interest you?

   Yes No

   Which opportunity(s)?

    AA Driver (Volunteer)
    Inpatient Detox Counselor (Volunteer)
    Outpatient Counselor (Intern)
    Detox Counselor (Intern)
   

   Which other program areas are you interested in?

    Behavioral Health (Addiction Recovery Center)
    Disease Control
    Environmental Health
    Family/Community Health
    Other
   

   If "other," please describe below.

3. Describe the opportunity(s) you are looking for:

4. Briefly describe your relevant experience and/or motivation:

5. Availability:

   Monday		Days
   Tuesday		Evenings
   Wednesday
   Thursday		How many hours can you commit per week?
   Friday
   Weekends		Less than 5 6-10 11-20 21-30 31-40

6. Language Proficiency:

   Are you proficient in a language other than English?	Yes		No
   If so, which language(s)?
   Please describe your level of proficiency in the above language(s):

7. Upload Resume:

   If you wish, you may attach your resume to this application. Enter the file name or browse to select the file. (Microsoft Word, ASCII text, or PDF preferred)

8. Spam Prevention:

   What is the month after June? (This question helps us prevent 'spam.'): *

Thank you for your interest in Boulder County Public Health! We will contact you shortly with additional information and application details.

Please be aware, we do not offer any paid internships.