Social Medicine Course Application: English
Thank you for your interest in the Haiti-based summer intensive Social Medicine Course, hosted by EqualHealth. This course will run from July 7-27, 2019 in Chicago, IL. We are re-opening applications following the relocation of the course from Haiti for security reasons. Please direct all questions and concerns to cfox@equalhealth.org
First Name *
Your answer
Last Name *
Your answer
Mailing Address *
Your answer
School *
Your answer
Year in program *
Your answer
Type of program (medical, nursing, public health, etc) *
Your answer
Email *
Your answer
Phone number *
Your answer
Skype ID *
Your answer
Date of Birth *
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Gender
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How will participation in this course better prepare you for your envisioned future as a professional and as a person, more broadly? *
Your answer
What is unique about you? *
Your answer
Where or amongst whom do you consider home? *
Your answer
What does partnership mean to you? Why might it be important in the field of health? *
Your answer
How did you learn about the course? *
Your answer
Financial Aid
EqualHealth is able to offer a limited number of tuition reductions to defray individual student costs. We have very limited capacity to grant these waivers, and we thus ask that you explore all other options before submitting a tuition waiver request. Over the years we have seen that many medical and nursing schools provide travel grants to students. In addition, local churches, Rotary clubs, and other community-based organizations are potential funding sources. Many students are able to raise money through crowd-funding sites such as GoFundMe. If you would like to be considered for a scholarship from EqualHealth, please complete the following questions.
How much do you feel that you are realistically able to contribute towards the cost of the course?
Your answer
If you were awarded a half scholarship of $1200 (out of a total cost of $2,400 + airfare), would you be able to attend the course?
If you are not awarded a scholarship, will you be able to attend the course?
Please provide as much of the following information as you are comfortable sharing: Are you employed or do you have another steady source of income? Do you have family or friends who can provide financial support? What will be your estimated debt upon graduation?
Your answer
What other potential sources of funding have you already explored? (Eg. Travel funds at your home institution, local community organizations, GoFundMe and other crowdsourcing platforms, etc.):
Your answer
Please provide any additional information regarding extenuating or unique circumstances of which you believe we should be aware in determining whether or not a scholarship is appropriate:
Your answer
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