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Care Coordination Team
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Community Health Education Program Application
For Current Students
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About
COVID-19 Info
History
Leadership
Providers
Hours & Locations
>
Over-the-Rhine
Rothenberg
TAFT
West
Harrison
Financial Information
Privacy Policy
Contact Us
Patients
New Patients
Current Patients
Support Groups
Paperwork
Resources
Feedback
Get Involved
Donate
Learn
>
Care Coordination Team
Volunteer Internship Program
Community Health Education Program
>
Community Health Education Program Application
For Current Students
Work
Donate Now!
Community Health Education Program Online Application
Applicant Information
*
Indicates required field
Name
*
First
Last
Email
*
Phone Number
*
Pronouns
*
she/her, he/him, they/them, etc.
Undergraduate School of Attendance
*
Undergraduate Major
*
Undergraduate Graduation Year
*
Graduate School of Attendance
*
N/A if not applicable
Are you pursuing any of the following pre-professional programs?
*
Pre-Medicine
Pre-Dental
Pre- Physician Assistant
Pre- Optometry
Pre- Pharmacy
Pre-Physical Therapy
Pre-Occupational Therapy
Pre-Law
Other Health Profession
Other Graduate Program
I am not enrolled in any of the above pre-professional programs.
I understand this is an unpaid position.
*
Yes
No
This is an unpaid position, but a wonderful opportunity to make an impact in an underserved community. You may be able to receive grant funding or class credit through your university.
I understand that this program requires a minimum commitment of 8-10 hours/month for one year.
*
Yes
No
Do you speak another language fluently?
*
Yes
No
If yes, what language(s)?
*
Have you previously applied to, or been involved with, a volunteer program at Crossroad Health Center?
*
Yes
No
Please indicate all times which you are available on weekdays, Mondays through Fridays, if you are chosen for an interview.
*
5:00 pm
6:00 pm
7:00 pm
8:00 pm
How did you hear about the Community Health Education Program?
*
Presentation or Email to Academic Class
Presentation or Email to Student Organization
Event (Health Fair, Conference, Seminar, etc)
Current Intern or Employee
Internet Search
Other website
Social Media
Other
Please provide one professional reference.
This is an individual who has overseen you in a professional setting, such as an advisor, supervisor, professor, or employer. Do not include a relative or friend.
Reference Name
*
Reference Email Address
*
Relationship to Reference
*
Please provide one peer reference.
This should be a peer who you have worked with or under in a professional or extracurricular or academic setting. Examples include a leader of a student organization, partner in a group project, or fellow student in a research lab. Do not include a relative.
Reference Name
*
Reference Email Address
*
Relationship to Reference
*
Supplemental Materials
The supplemental materials includes four components:
Essay #1:
Why is it important to educate others about stigmatized topics such as sexual health?
250 word maximum, single-spaced.
Essay #2:
Describe a time when you took initiative to solve a problem.
250 word maximum, single-spaced.
Essay #3:
What experiences have you had working with people from backgrounds different from your own? How would you approach working with them?
250 word maximum, single-spaced.
Professional Resume:
2 page maximum
Submit the supplemental materials as one PDF with the title in the format of Lastname_Firstname.pdf.
*
Max file size: 20MB
Please submit your resume and personal statement as one PDF with the title in the format of Lastname_Firstname.pdf.
It is the policy of Christian Community Health Services to ensure equal employment opportunity in accordance with the Ohio Revised Code 125.111 and all applicable federal regulations and guidelines. Employment discrimination against employees and applicants due to race, color, religion, sex, national origin, disability, age, military status, or veteran status is illegal.
Submit
