Healthcare Interest Program (HIP)

*A mentorship program for University of Colorado Denver students interested in a healthcare career.

*A Denver Health Hospital Program

Application for Academic Year 2016-2017

Please fill out electronically, attach a copy of current academic transcript and email back to

Deadline is July 22, 2016

Incomplete or late applications will not be considered

Healthcare interest program

Program and Course Description:

The purpose of this mentorship program is to support undergraduate pre-health students who are attending the University of Colorado-Denver seeking healthcare professions. Participants will gain valuable shadowing experience within a healthcare environment, bridge educational science concepts to healthcare application, and develop relationships with current healthcare providers. HIP will expose participants to Denver Health, an urban safety-net hospital and clinic program that primarily serves the underserved population of Denver County. Students can expect to shadow physicians and other healthcare providers in the hospital or clinic setting, attend lectures that connect basic science coursework with real-world healthcare topics and health disparities, and take part in a book club. In completing the program, students should have a better understanding of the healthcare experience, how general science concepts are used in the healthcare setting, and have an augmented perspective on their future career goals.

HIP Program and Course Requirements (The applicant should show):

-Completion of and grade in Biology I, Chemistry I, and Physics I

-Currently enrolled and in good academic standing at the University of Colorado-Denver

- 2.8 GPA (by submitting copy of current academic transcript)

HIP Program Course Objectives (The student, by the end of the year, should):

  • Develop a mentor relationship with a formally assigned mentor in the healthcare field
  • Develop a mentor relationship with HIP program staff
  • Gain individualized insight into personal career goals
  • Develop supportive relationships with students at UCD who have similar healthcare interests
  • Gain awareness of health inequity by participating in didactics, community service, and readings

Projected Schedule--as you apply, please consider these mandatory events:

  • Interviews: 12 of Augus 2016
  • Kick Off Meet & Greet: 26 August 2016
  • HIP Orientation: TBD
  • Books to Bedside Friday lectures,8am -4pm: TBD
  • Health Inequity Lectures Friday lectures, 1130-1pm: TBD
  • Mentor Shadowing, 4 hours a month on Fridays: TBD
  • Mentor Life Coaching, additional time with mentors once a month: TBD
  • Winter Social: TBD
  • Community Service Project: TBD
  • HIP end-of the year reception: TBD

*Keep in mind that you will have HIP activities almost every Friday (all day)*

PERSONAL & ACADEMIC INFORMATION

A. Personal Information

1. Name______

LastFirstMiddle

2.Current Mailing Address:

Street and number______Apt ______

City ______State ____ Zip ______

Home Telephone ( ) ______

Cell Telephone ( ) ______

3. Permanent Mailing Address (if different from above):

Street and number______

City ______State _____ Zip ______

Telephone ( ) ______

4. School email address ______

5. Non-school email address ______

B.Family Background

1. Father: Living___ Deceased ___ Mother: Living ____ Deceased ___

Occupation : ______Occupation: ______

Highest Education______Highest Education_____

2. Number of brothers: ______Ages ______

Number of sisters: ______Ages ______

C.Education/ Healthcare Interest

1. List in chronological order, beginning with high school, the schools you’ve attended or are presently attending and whether or not a degree was granted.

INSTITUTION / MAJOR FIELD / DEGREE / DATES ATTENDED

(For any of the following questions, please use extra room as you need to fully answer the questions.)

2. What is you present classification in college: Freshman__, Sophomore__, Junior __, Senior __

3. What is your college Major? Minor?

4. What date you expect to graduate from college?______

5.What is/are your healthcare career interest(s)? Pharmacy ___, MD ___, DO ___,

RN ___, NP___, PA ___, PT/OT ___, Public Health ___, Dentistry ___. Choose one or

and in the space below, elaborate (for example, if you chose MD you might tell us what field most excites you).

6. Have you ever had any experience working in, volunteering in, or shadowing in a healthcare field? If so, how many months and in what area? Briefly describe what you did.

7. Have you ever had any experience working in a science laboratory or doing research? If so, for how many months and in what area? Briefly describe what you did.

8. Do you have a healthcare mentor? If so, tell us about him or her.

9. Are you currently applying or have applied to University of Colorado UPP program? If so when are you expected to start the program?

10. Have you participated on the University of Colorado UPP program in the past?

11. Is anyone in your family in the healthcare field (for example, physician, dentist, nurse, CNA, phlebotomy, any other)? If so, who is that person and what is their job?

12. Discuss what motivates you to succeed.

13. List any obstacles or barriers you see before you in achieving your goals.

14.What do you think is the most important thing you can do to improve you chances of being accepted into your healthcare graduate school of choice?

15. On a scale of 0-10, rate your current level of confidence in being accepted into a future graduate school in a healthcare field:(0 means you have no confidence and 10 means you have no doubt): ______

Explain why you chose the number that you did.

16. What has been your MOST favorite science class in college? Explain your answer.

17. What has been your LEAST favorite science class in college? Explain your answer.

18. What do you see yourself doing in 5 years?

19. May we contact you in 3 years to see if you have enrolled in your graduate school in your healthcare field of choice?

20. What was the last book you read?

21. Look at the objectives of the course (second page of this packet). Using those objectives in your answer, tell us why we should pick you for the HIP Class of 2016-2017.

PERSONAL DATA

Completion of the following information is optional

Completion of this section is strictly voluntary on your part and refusal to provide this information will not subject you to being denied into the program or unfair treatment. Your cooperation will enable us to track populations served through HIP. The information on this form will be treated in a confidential manner.

Date of birth: ______

Sex: Female ____ Male______

Race (check all that apply):

_____ Black (includes of African and Eastern Indian descent)

_____ Native American (Includes Alaskan Native)

_____ Asian

_____ Caucasian

Ethnicity (check all that apply):

_____Hispanic/Chicano/Mexican American/Latino, describe: ______

_____ Native Hawaiian/Pacific Islander

_____ African American

_____ Other African, describe: ______

_____ Asian, describe origin: ______

_____ Native American, name nation: ______

First Generation College(you are the first in family to be on track to complete a 4-year college degree. No parent has completed a 4-year degree)______

Is English your first language?______If not, name first language ______

Are you working while in school?

What is your job?

Are you a veteran?

Do you have a learning disability?

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