Student Leadership Board Application
2016-2017
Application Timeline
Board Meet-and-Greet:
Wednesday, November 4, 2015, 6:00-7:00 p.m., TAC Lobby
Applications due:
Tuesday, November 10, 2015 at 11:59 p.m.
Interviews for board positions:
Wednesday, November 12 –Thursday, November 19, 2015
All positions listed below begin in January 2016 and go through mid-February 2017.
How do I apply?
Please fill out this application, limiting your application to 2 pages or less. Please paste your updated
CV/resume at the end of this application. As you prepare your application, please keep in mind that we will
consider you for all the board positions in which you express interest (please see question #1).
Please save this file as <Your First and Last Name – HAVEN Free Clinic Board Application 2016-2017> and
return your completed application to havenfreeclinic@gmail.com by 11:59 p.m. Tuesday, November 10, 2015.
We will contact you soon after receiving your application to schedule an interview.
Note: To check a box, double click on it and select the “checked” option.
Application
Name:
Yale Email Address:
Phone #:
Gmail Address*:
NetID*:
Program/School:
Epic Login (if available):
Year:
Spanish ability (Spanish is only required for indicated departments, but we ask that all applicants indicate their
ability):
None
Fluent – Non-native speaker
Some
Fluent – Native speaker
Conversational
Please indicate all evenings you are available for an interview (interviews will be 20 minutes and will be
scheduled between 6-9 pm):
Wednesday, November 12
Monday, November 17
Thursday, November 13
Tuesday, November 18
Friday, November 14
Wednesday, November 19
* We ask for NetIDs and Gmail addresses so we can immediately begin the process of giving new board
members access to HAVEN’s HIPAA-protected server, and Google documents/calendar.
HAVEN Free Clinic Board Application 2016-2017
1. In which positions (of those listed in the accompanying document) are you interested? (Please rank in order
of interest with #1 being your top choice)
1)
2)
2. Please tell us why you are interested in serving on HAVEN’s Student Leadership Board. If you have
previously worked at HAVEN Free Clinic, please tell us about your experience thus far at the Clinic and why
you want to become more involved. (Prior HAVEN volunteering is not a requirement, but if you have it,
please tell us about it.)
3. What experience have you had that would prepare you to help run the HAVEN Free Clinic?
4. Describe your experience in administrative/organizational leadership positions. If possible, please comment
on any experiences you have had supervising your peers.
5. What do you believe should be important priorities for a student-run free clinic?
6. What other significant time commitments do you have or anticipate having next year? What are your plans
for the summer (even if they are only tentative)?
7. Please provide any additional information you think that we should know.
8. Please copy and paste your CV/resume in the space below. This is NOT included in the page limit for your
application.
Thank you so much for applying. We are excited to meet you and
learn more about your interest in HAVEN!
HAVEN Free Clinic Board Application 2016-2017