CHHS Organization Application

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—The CalState S4 Team

California State University Monterey Bay
COLLABORATIVE HEALTH & HUMAN SERVICES (CHHS) FIELD PRACTICE PROGRAM
100 Campus Center, Ocean Hall Suite C, Seaside, CA 93955-8001
(831) 582-4161 * Fax: (831) 582-3899 * chhsfield@csumb.edu * https://csumb.edu/hhspp

 

FILL OUT INFORMATION ABOUT SPECIFIC SITES WHERE STUDENTS WILL BE PLACED.

I. Program Site Information

Note: You only need to fill out general site information if the site where students are serving is a different location than the information provided as the main organization.
(example: Santa Cruz County Health Services fall under an agreement with the County of Santa Cruz)

Please list all Mentors at this site:
First NameLast NameTitlePhone numbere-mail

II. Specific Site Information

Please provide detailed information in the section below about your site, and what students will be doing at your site.

Students will be searching this information to find a good match with their skills and areas of interest.