Delta Rural Health Internship Site Application

Delta Rural Health Internship Site Application

Entity Legal Name

Type of Site

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Mailing Address

Preferred Phone Number

Preferred Email Address

Contact Name

Name of Certified Biller Currently On Staff

Are you able to provide Apprenticeship placement?

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Are you willing to assist in on the job training?

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Please select Parish/Parishes sites represent

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Type of Accreditation

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