STEMCDI

Collegiate Health Services Corps

2016-2017APPLICATION

The City College STEM CDI has partnered with the Manhattan-Staten Island Area Health Education Center to provide the Collegiate Health Service Corp (CHSC) exclusively to City College Students. The STEM CDI will give participating students the training, experience and support they need to be competitive in career searches and professional school admissions processes. Through a series of carefully designed projects, workshops and training sessions, participants work to:

  • Increase their marketability and earning potential
  • Develop skills to conduct successful job or graduate school searches
  • Establish professional contacts

In addition to access to these trainings, CHSC participants will have experiences designed for those interested in a career in health care. The CHSC is designed to introduce undergraduate students to health careers through service learning experiences. CHSC participantsinternat health facilities located in medically underserved areas and help address community health needs.

Eligibility Criteria

□Applicants must be CCNYsophomores or juniors(during Fall 2016) with GPAsof at least 2.7 in a STEM major with plans to pursue a health field (medicine, nursing, dentistry, etc.) and maintain at least half time enrollment status.

□Applicants must be able to commit to the following:

  • All CHSC participants will complete a minimum of 100 hours at their project/leadership placement from January 2017 to May 2017. Projects will vary depending on participant interest and service learning site placement.
  • A minimum of five hours a week at their placement;
  • Attendance and completion of all training sessions;
  • Participation in a mock interview;
  • Mandatory attendance of and participation in 6 reflection sessions held on Saturdays (one per month starting in October).

Instructions

Please complete the application form below. You may return the application to us by printing out the completed application and delivering it to the address below or you can save the form, and then email the form with the required application materials to the e-mail address below.Please return the completed application with the essay, resume, and unofficial transcript to:

Emiko Morimoto, Associate Director of STEM CDI

Shepard 10C

-or-

Name: ______Date: ______

Ethnicity: Date of Birth: ______

□American Indian or Alaskan Native

□Asian (Cambodia, Malaysia, Pakistan, Vietnam)

□Asian (China, Philippines, Japan, Korea, India)EMPL ID#______

□Black or African American

□Hispanic or Latino

□Native Hawaiian or other Pacific IslanderOther Language(s) Spoken:______

□White

□Other/Multiracial ______

Gender: ______

Major: ______Anticipated Date of Graduation:______

Address: ______

Street Apt/Suite

______

CityState zip code

Permanent Address (if different from above): ______

StreetApt/Suite

______

City Statezip code

Phone Number: ______Cell Phone Number: ______

Area code Area code

CCNY Email Address:

Preferred Email Address (if not your Citymail account): ______

Resume:

Please attach a copy of your resume.

Unofficial Transcript:

Please attach a copy of your unofficial college transcript.

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STEMCDI

Collegiate Health Services Corps

2016-2017APPLICATION

Please rank your top three Primary Care Fields (1 as top choice):

___Family Medicine ___Emergency Medicine ___Pediatrics ___ Mental Health ___Dentistry

___Nursing ___Other Allied Care Profession______

Explain

Please rank three Service Learning Projects in order of interest (1 as top choice):

___Obesity Education ___HIV/AIDS Prevention ___Asthma Awareness ___Diabetes Education

___Health Care for the Homeless ___Adolescent Health Issues ___Pre-Natal Care Education

___Preventing Domestic Violence ___ Oral Health Awareness ___STD/STI Prevention

___Other______

Explain

Essay:

On a separate document please describe your interest in the health professions and explain the importance of working with medically underserved populations. Please explain how participation in the CHSC program will help you in your pursuit of a health career.

Are you a former MSI AHEC Participant?

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STEMCDI

Collegiate Health Services Corps

2016-2017APPLICATION

□Yes ______

Program(s)

□No

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