Applications are due by midnight on Saturday, May 5th
Health Leads Volunteer Application
Summer 2012
Please save this document in the following format LastName.FirstName.Summer2012.doc and email
your completed application to apply@healthleadschicago.org
Health Leads mobilizes the nation’s undergraduates to provide high-impact services to low-income
families and, in the process, to transform our healthcare system into one that is more effective and more
just. We believe that undergraduates have what it takes to effect this transformative change, and we are
always seeking passionate, committed students to join our movement.
If selected to join the Health Leads team, you will be expected to:
() Dedicate seven hours a week for three quarters
() Fulfill all program expectations as outlined in the application info packet, including participation in all
training sessions.
() Participate in weekly Reflection Sessions and periodic campus events with fellow volunteers.
() Contribute actively to the development of the Health Leads programs and vision in whatever ways most
interest and inspire you!
Please indicate that you have read the separate information document in full and understand the
expectations of the volunteer role in Health Leads
 I have read and understand the expectations of the volunteer role in Health Leads.
Applicant Information
Name:
Preferred E-mail:
Preferred Phone:
Year:
Major:
How did you hear about Health Leads?
Have you applied to Health Leads in the past? If so, when and to which programs?
Do you speak any languages other than English? If so, which ones and with what proficiency?
What other commitments will you have this summer, and about how many hours/week do you
anticipate devoting to them?
Please tell us as much about your day-to-day schedule during the time period in which you would
like to volunteer as possible. Any time constraints in terms of hours, days of the week, or time
periods should be listed.
Please indicate your first choice program (Chicago Family Health Center or LaRabida Children’s
Hospital):
Applications are due by midnight on Saturday Jan. 7th
Please mark your availability for shifts by placing an X where you ARE available:
For CFHC: We are assessing availability for two different morning shifts. The shift from 8:30-12
means you will be back on campus in time for 12pm class. Please mark your availability for both, and
we will schedule the shift as best fits volunteers and the clinic. Thanks!
Program
Monday
Tuesday
Wednesday
Thursday
Friday
CFHC 9:30-1pm
CFHC 1:30-5pm
La Ra 8am-12pm
No Shift
No Shift
La Ra 12pm-5pm
Please mark your availability for an interview by placing an X where you ARE available:
Times
8:30 am - 9:00 am
9:00 am - 9:30 am
9:30 am - 10:00 am
10:00 am - 10:30 am
10:30 am - 11:00 am
11:00 am - 11:30 am
11:30 am - 12:00 pm
12:00 pm - 12:30 pm
12:30 pm - 1:00 pm
1:00 pm - 1:30 pm
1:30 pm - 2:00 pm
2:00 pm - 2:30 pm
2:30 pm - 3:00 pm
3:00 pm - 3:30 pm
3:30 pm - 4:00 pm
4:00 pm - 4:30 pm
4:30 pm - 5:00 pm
5:00 pm - 5:30 pm
5:30 pm - 6:00 pm
6:00 pm - 6:30 pm
6:30 pm - 7:00 pm
7:00 pm - 7:30 pm
7:30 pm - 8:00 pm
8:00 pm - 8:30 pm
8:30 pm - 9:00 pm
Mon. May 7th Tue. May 8th
Wed. May 9th Thurs. May 10th
I am available from 10am-4:00pm on both days of training (Saturday, June 17th and Sunday,
June 18th)
Please continue to the open response questions!
Open Response Questions
Please answer the questions below in 1-3 paragraphs each.
1.
What draws you to work with Health Leads? What do you hope to get out of your experience
with Health Leads?
2.
Given the description of the volunteer role in Health Leads, what qualities, skills, or
experiences do you imagine would help a volunteer to be successful in this role? Within this
spectrum, please identify a few qualities or skills that you are confident you could bring to
the role, and a few that you’re less confident about. (Feel free to draw examples from past
experiences in your responses, if relevant.)
3.
Describe an effective community or team in which you have participated and the role you
took in it. What made that community or team work well? How did you relate to or work
with the other members of that community or team?
4.
Our programs require volunteers to partner with various stakeholders—including parents,
children, healthcare professionals, community leaders, and fellow volunteers—whose
backgrounds might be different from their own. Please share an experience in which you’ve
engaged in a partnership with an individual whose perspective or experience differs from
yours (could be generationally, culturally, etc.). How did you build and maintain that
partnership?
Thank you for your application.
We look forward to working with you