Roots Fellowship Application
Thank you for your interest in Roots. The Roots Fellowship Program is a 10-week, part-time or full-time program. Fellows will gain experience working with the social determinants of health from a variety of angles. Applicants should be committed to uplifting those impacted by systematic inequities and poverty in accordance with Roots' mission. If you have any questions about the application, please contact Molly Calhoon at molly@rootsclinic.org.
Email address *
Contact Information
First Name *
Your answer
Last Name *
Your answer
Permanent Address *
Street, City, State, Zip Code
Your answer
Current Address
If different from above.
Your answer
Cell Phone *
Your answer
Email Address *
Please note that email is our primary form of communication.
Your answer
Select the area(s) of service in which you are interested. *
Please check all that apply. See descriptions above for tentative scope of work for each area of service.
Required
Availability & Commitment
Roots Fellows work 15-40 hrs/wk for at least 10 weeks. Start and end dates are flexible, but you must be available to work for 10 weeks to be considered for a fellowship. We will attempt to place you in your top area of interest, but you may be placed in a different area based on qualifications and organizational need.
Earliest Available Start Date *
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Length of Commitment *
Please indicate how long you would like to work with Roots. (Must be at least 10 weeks for fellowship)
Your answer
Availability *
Please indicate your availability.
Required
Availability Details
Please use this space to provide more information about your availability. If your schedule is subject to change, please let us know.
Your answer
Education & Employment
Educational Background *
Please list schools attended (such as high school, college, post-graduate) and any other training you'd like to share. Please include graduation year and majors, if applicable.
Your answer
Education Requirements/Credits *
Are you looking to volunteer in order to meet school requirements or for credit?
Education Requirements/Credits - Additional Info
If you answered "yes" to the above question, please tell us your school/program's name, and explain the requirements your volunteer commitment needs to meet (e.g., hours, type of work, timeline, supervision, etc.)
Your answer
Employment *
If you are currently employed, please tell us where, hours per week, job title, and any other information you'd like to share. If not, please type N/A.
Your answer
Relevant clubs/organizations
Please list any relevant organizations or clubs where you have been involved in the past (or currently).
Your answer
Why are you interested in volunteering at Roots Community Health Center? *
Your answer
If you have ever worked or volunteered in a clinic/hospital before, please list your responsibilities here.
Your answer
Do you speak/read/write any languages other than English? Please list and indicate ability for each language.
Your answer
Do you have any physical/mental/medical conditions that would affect your work capacity? If so, please explain.
Your answer
How does the Roots Fellowship Program fit into your overall career goals? Please answer in under 250 words. *
Your answer
Evaluate a significant experience, achievement, or risk that you have taken and its impact on you. Please answer in under 250 words. *
Your answer
Terms and Conditions
Please carefully read the following statements and input your initials if you agree/accept the terms.
I have answered each question fully and correctly. I understand that any deliberate misstatement will disqualify me, or will cause the immediate termination of my volunteer assignment.Initial and indicate that you agree/accept the terms. e.g., G.H (agree) or if you don't agree then G.H (disagree) *
Your answer
If accepted as Roots Fellow, I agree that I am committed to at least 10 weeks of service and will work a minimum of 20 hours a week for the duration of that 10 weeks. *
Your answer
If accepted as Roots Fellow, I agree that I shall hold as absolutely confidential all information that I may obtain directly or indirectly concerning patients, doctors, or personnel, and not seek to obtain confidential information from any patient. *
Your answer
If accepted as Roots Fellow, I agree that my services are donated to the Roots Community Health Center without expectation of compensation or future employment. *
Your answer
If accepted as Roots Fellow, I agree that I shall be punctual and conscientious, conduct myself with dignity, courtesy, and consideration of others, and endeavor to make my work professional in quality. *
Your answer
If accepted as Roots Fellow, I agree that I shall attempt to resolve any problems related to my volunteer activities with my volunteer coordinator, and, if unsuccessful, attempt to resolve any such problems with the CEO of Roots. *
Your answer
If accepted as Roots Fellow, I agree that I shall make my best effort to fulfill all assignments that I accept. *
Your answer
If accepted as Roots Fellow, I agree that I shall at all times uphold the philosophy and standards of the Roots Community Health Center. *
Your answer
I understand that the Volunteer Services Department reserves the right to terminate my fellow status as a result of (a) failure to comply with clinic policies, rules and regulations; (b) absences without prior notification; (c) unsatisfactory attitude, work, or appearance; or (d) any other circumstances which, in the judgment of the department director, would make my continued service as a volunteer contrary to the best interests of Roots Community Health Center. *
Your answer
I have read each of the above conditions and I agree to be bound by each of them. *
Your answer
A copy of your responses will be emailed to the address you provided.
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