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LOCATION AmericInn Chamberlain DATE October 19 2016 APPLICATION DEADLINE October 5 2016 PLEASE COMPLETE APPLICATION PRINT SIGN AND MAIL TO Jessica Neilan Sanford Mid-Dakota Medical Center 300 S. Byron Blvd. Route 8673 Chamberlain SD 57525 FOR MORE INFORMATION Phone 605 234-7217 PERSO N AL INFO RM ATI O N print or type Student Name Home Address City State Zip Phone Email Date of Birth Ethnicity Gender Male Female African American Asian Caucasian/White Hispanic/Latino Native American Other Have...

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