Applications are due midnight on Saturday, Oct. 1
Health Leads Volunteer Application Summer 2011
Please save this document in the following format
LastName.FirstName.Summer2011.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 midnight on Saturday, Oct. 1
Please mark your availability for shifts by placing an X where you ARE available:
Program
CFHC 9:30-1pm
CFHC 1:30-5pm
La Ra 8am-11am
La Ra 12pm-4pm
Monday
Tuesday
Wednesday
Thursday
No Shift
No Shift
Friday
Saturday
No Shift
No Shift
No Shift
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. Oct. 3rd
Tue. Oct.4th
Wed. Oct. 5th
Thurs. Oct. 6th
I am available from 10am-3:30pm on both days of training (Saturday, October 8 and Sunday, October 9)
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