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Intern/Student Application

Intern/Student Application

The form below is intended for the use of students interested in an internship or clinical preceptorship hours.  Please only fill out the form if you are a student.  If you are interested in applying for a position within the Memorial Hospital organization, please go to https://www.mhtlc.org/careers/

This application cannot be saved or completed partially. Please make sure you have all of the following information before entering the data.   Once you have completed the application and submit your uploads, please click “submit” at the bottom of the page.  After completion, the AHEC office will be in contact with you regarding your request.  If you have any further questions, please contact Mary Jane Clark via email mclark@mhtlc.org  or via phone at 217-357-6832.


Click here to fill out the additional information form when prompted by hospital staff.

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