Stanford Patient Advocacy Program
Application for 2008-2009
Please review all program materials carefully before applying. (
All application materialsare due by February 15, 2008 to
Stanford-Based Course
MED 257A/B/C: Patient Advocacy in Community Clinics is designed to provide students with concrete skills for working with patients in community health clinics, and to broaden and deepen students' understanding of the context of this work and of the populations being served. Regular Monday evening classroom meetings serve as a forum for discussion of class readings, clinic experiences, and for skills training. All students in the program are required to commit to weekly shifts at one of the clinic partner sites throughout the academic year. Students interested in taking the course for a letter grade are required to design and complete a year-long project that meets a clinic-identified need.
Units/Grading:3-4 units, letter grade option
Requirements: commitment to3 quarters of enrollment, Spanish or Vietnamese proficiency
Instructors:Gabriel Garcia, MD & Ann Banchoff, MSW, MPH
Clinic-Based Program Partners
Arbor Free Clinic
795 Willow Road, Menlo Park, CA94025 – carpools available (15-20 min drive)
Arbor was established in 1990 by Stanford medical students. This student-run Sunday clinic provides quality free health care services to medically uninsured residents of San Mateo, Santa Clara, and Alameda counties. Current patient population: Hispanic and African-American adults and some children. Arbor also serves as an interactive, clinical learning environment for Stanford medical students and undergraduates.
Shifts: Sundays 9:45am – 3:00pm (requirement: 4+ shifts/quarter)
MayView Community Health Center
270 Grant Avenue, Palo Alto, CA94306 – accessible by marguerite
100 N. Moffett Blvd., Suite 101, Mountain View, CA94043-- accessible by train (15 min drive)
Provides high quality primary health care to people from all cultural and ethnic backgrounds regardless of their ability to pay; serving 4,000 patients with >14,775 services per year. Current patient population: Hispanic monolingual Spanish-speaking families.
Shifts vary by site. Evening shifts available at both locations; Saturday shifts available at the Mountain View site.(requirement: 4 hr shift/week)
Pacific Free Clinic
1835 Cunningham Avenue - San Jose, CA95122 – carpools available (30 min drive)
PFC was established in 2003 by Stanford medical students.This student-run clinic operates on Saturdays as a clinical learning environment that provides free health care services to the medically uninsured--particularly immigrants with low English proficiency.Current patient population: Vietnamese and Hispanic adults.
Shifts: Saturdays 9:45am – 3:00pm (requirement: 4+ shifts/quarter)
Belle Haven (RavenswoodFamilyHealthCenter)
100 Terminal Road,Menlo Park, CA94025 -- (15-20 min drive)
Belle Haven is one of the clinic sites part of the Ravenswood Family Health Center (RFHC). Since 2001, RFHC has been a nonprofit medical clinic offering primary health care services to SouthSan MateoCounty residents, regardless of ability to pay. RFHC works to eliminate cultural and language barriers to health by providing bilingual medical staff & health education services. Current patient population: Hispanic and African-American seniors.
Shifts: M, T, Th, 1:00pm-5:00pm; W, Th 8:30am-12:30pm (requirement: 4 hr shift/week)
Samaritan House Free Clinic
114 5th Ave.,Redwood City, CA94063
Established in 1974, Samaritan House is a non-profit health and human services agency that runs a Free Clinic for low income individuals in San Mateo County, CA.
Shifts: M-F 9:00am-12:30pm, 2:00-5:00pm (requirement: 4 hr shift/week). Current patient population: Hispanic monolingual Spanish-speaking adults.
Stanford Patient Advocacy Program Application 2008-2009
Applications and resume are due by February 15, 2008 to .
Name:Email:
Year/major:Phone #:
Summer Contact Info (if different from above):
1. Why are you interested in committing to the Patient Advocacy Program? (500 words or less)
2. What personal attributes, skills, or experiences would you contribute to this program? (500 words or less)
3a. Please rank your community partner preferences (1st, 2nd, 3rd , etc.).
___ Arbor __ MayView @ Palo Alto ___ MayView @ Mountain View __Belle Haven __Samaritan ___PFC ___ no particular preference
3b. If applicable, please briefly describe reasons for clinic preference.
4. Spanish or Vietnamese proficiency is necessary for Patient Advocates to effectively serve partner clinics.
*Students must pass a language proficiency exam in order to enroll in the program.
Please report your Spanish or Vietnamese speaking proficiency on the following scale:
Select Language: ___ Spanish ___ Vietnamese
1 / 2 / 3 / 4 / 5 / 6 / 7(Unable to converse) / (Comfortable with basic conversation/ expressing simple ideas) / (Very comfortable expressing yourself/ comprehending dialogue) / (Native fluency)
If you speak another language, please report your speaking proficiency in that language.
Language:______1234567
5. Please list related course work that you have taken or plan to take.
6a. Do you have access to a car to drive to clinic shifts? __ Yes __ No
6b. Are you willing to take public transportation to clinic shifts? __ Yes __ No
7. What other activities will you be involved in during the 2008-09 year, and how much time do you expect to devote to them?
8. Please list contact information of two references. (Include full name, relation to applicant, email, and phone number.)
9. Please attach an updated resume.
My signature below indicates that I have read and agree to accept the responsibility and commitment required of students in the Stanford Patient Advocacy Program.
Signature:______Date:______