HERC Intern Application

HERC is Searching for Interns!

	Asthma Internships
	HERC will train interns to teach the American Lung Association’s Asthma curriculum in various schools and childcare facilities in Bayview Hunters Point.
	Cancer Outreach Internships
	We are also looking for women interested in being trained to conduct door-to-door home visits that will focus on breast and cervical health, and both men and women for prostate health outreach.
	In exchange for your commitment, you will receive:
	Free Training by the American Lung Association and/or Cancer Awareness Training Certificate of Completion An opportunity to help others A small stipend
	Please fill out registration form below and E-mail ( *Submit* button) or print and send to:
	HERC 828 Innes Ave., Suite 110 San Francisco, CA 94124 Telephone: (415) 401-6810

	Minimum Requirements:
	CA Driver's License or ID Must be fingerprinted Must have recent TB test
	I Accept/Have All the Requirements: YES NO

All starred (*) contact information must be filled in.
Personal information is for HERC'S use only and will be kept confidential.

First Name:* Initial: Last Name:*

Street Address:* Apt : Zip Code:*

Home Phone:* Other Phone:

E-Mail:

I want to volunteer for:* Asthma component Cancer component

Select all that apply:

I am the parent of an asthmatic I know someone with breast, cervical or prostate cancer

I am an asthmatic I have medical experience

I know someone who’s asthmatic I have teaching experience

I have had breast, cervical or prostate cancer