Health and Medical Apprenticeship Program

Health Service Internship Application

For Spring 2017

Name:______Email:______

SID#:______

Full Local Address:______

Permanent Address:______

Local Phone #:______

Date of Graduation:______Major: ______

How did you hear about this internship? (Mark all that apply)

___ On-campus flier ___ Class Announcement ___ Email List

___ PH116 Lecture ___ Current/former intern ___ PH116 Section

___ Friend Other (please state):______

Referral:______

APPLICATION INSTRUCTIONS

(please read thoroughly and carefully)

The Health Service Internship (HSI) is a program that requires devotion and a whole-hearted commitment to service learning and community contribution. HSI requires a minimum of 6-8 hours a week, and it is preferable to have two to three 4-6 hour time blocks in your schedule to complete this. Weekly discussion sections are held Tuesday, Wednesday and Thursday evenings, and there will be several mandatory events throughout the semester in addition to this. Please consider your time commitments and availability in Spring 2017 before completing this application.

Please answer the following questions thoroughly and concisely. Answers to each question should not be longer than 1 page. The total number of pages in your application, not including these first two pages, should be seven pages or less. Answers must be typed with the following format: Times New Roman, 12-point font, double-spaced. DO NOT put your name on any of the pages of your application except for this cover page (this is to ensure anonymity in the review process). Please email in your typewritten answers and a photocopy of your Student ID as two separate PDF files.

Submit your application and copy of your ID to by 5pm on Friday, October 28th, 2016. You will receive an email after 10:00 am on Tuesday, November 8, 2016 for list of applicants granted an interview. If you have been granted an interview, sign up for a time slot through the link provided in the email. Be sure to sign up for an interview by 5:00 p.m. on Friday, November 11, 2016. The interview schedule will finalized after this time. Interviews will be held November 14-18, 2016.

QUESTIONS:

1. (a). Why do you want to apply for an HSI internship? Please address the various components of the HSI program: internship, section, etc.

(b). What kind of experience are you expecting from an HSI internship (You may wish to tell us what kind of organization you would like to work with, what kind of work you would like to be doing, etc.)? Note that your answer to this question will not be a commitment on your part or ours as to an eventual placement with HSI.

2. What are your plans for the future? How will an HSI placement contribute to these goals?

3. What sort of challenges might you anticipate in an HSI placement? What situation(s) would make you uncomfortable in a placement?

4. What, specifically, about volunteering is important to you? Please share a personal experience that has prompted you to volunteer for this internship. If you do not have a personal experience to write about, why do you want to make a significant contribution of time volunteering in the community (6-8 hours a week)?

5. What current public health or social issue concerns you the most and why?

6. If you could have dinner and conversation with anyone living, deceased, or fictional, with whom would you have it and why?

7. Please list the classes you will be taking next semester in addition to all other time commitments (work, MCAT/GRE classes, extra-curricular activities, etc.) that you will be participating in next semester. How do you plan to work HSI into your schedule? Attach a screenshot of a tentative schedule (including classes and extra-curriculars).

If you should have further questions about the program or application process, please email Grace Jenks at .

APPLICATION CHECKLIST

□  Cover Sheet

□  Typed answers

□  12 pt font, Times New Roman, double-spaced

□  Don’t put your name on these pages

□  Copy of your Student ID Card as a separate attachment

□  Turn in online by Friday, October 28th at 5:00 pm!

You will receive an email regarding your application status on TUESDAY, November 8th after 10:00 AM. If you have been granted an interview, sign up for a time slot via the link provided by 5:00 PM ON FRIDAY, November 11th.

Health and Medical Apprenticeship Program (HMAP)

PH 97/197 Sponsored by the School of Public Health

ASUC Student-Initiated Student Group