Fall 2014 Application CHSC
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Name *
Preferred Email Address *
Phone Number *
Major(s) and Minor(s) *
Semester Standing *
Please list your first choice site for Spring 2014 *
Would you be willing to drive a Community Outreach Vehicle to site? *
(Training is provided.  Must be over 18, with a good driving record, and have had license for at least 2 years.)  
Are you able to discuss health topics in simple, conversational Spanish? *
*Note: This is NOT a requirement to be a part of the program
Of the following open sites, please choose all for which you are available: *
Please only mark those sites which you can comfortably make (transportation times included)
Required
Please list your second choice site for Spring 2014 *
Are you eligible for Work Study *
Please list your third choice site for Spring 2014 *
How did you find out about Collegiate Health Service Corps? *
(List all sources used)
Are you involved with anything else on campus? *
Please list any health or teaching related volunteer or work experience: *
What do you expect to gain from your service with underserved populations? *
If you could be a untensil, what would it be and why? *
We are reserving three days for interviews; please pick 3 potential times total that work for you among any of the 3 dates!
See the three questions below, please disregard the answer option for this question
What interview times are you available, should you be selected?
The dates refer to Sunday, February 2nd
What interview times are you available, should you be selected?
The dates refer to Monday, February 3rd
What interview times are you available, should you be selected?
The dates refer to Tuesday, February 4th
Will you be able to attend a mandatory Core Training session on Sunday, February 9th? *
This will be held from 10:00 AM - 1:00 PM
Thank you for your application! If selected, we will notify you for your interview time by the evening of Friday, January 31st. Please be ready for your interview!
Feel free to leave us any questions or comments!
If any of the interview times listed above do not fit into your class schedule, please comment below with a time during the evening hours another day that does work for you.
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