HEALTH CAREERS CAMP CFAHEC

Transcription

1 5 DAY FREE RESIDENTAL CAMP FOR STUDENTS INTERESTED IN PURSUING CAREERS IN HEALTH CARE JUNE 19-23, 2016 AT UCF HEALTH CAREERS CAMP CFAHEC Hands on tours and presentations can include: UCF s College of Medicine, UF School of Pharmacy, nursing, dental hygiene, medial helicopter, respiratory therapy, robotics, medical examiner, surgical simulators, operating rooms, social work, emergency medical technician, radiography, dentistry, HIV/AIDS, poison control, yoga, occupational therapy, medical careers in the military and more. Applications are due April 30, 2016 The camp is open to high school students who attend school in Orange, Seminole, Osceola, Lake, Sumter, Highlands, Hardee, Brevard and Polk Counties. Contact Information:Information: Jennifer Wolowitz, DHSc, MPH, CTTS Jennifer@cfahec.org ext. 102 Current Freshman, Sophomores, and Juniors can apply The camp is on facebook at Central Florida AHEC Health Careers Camp

2 Participant Application Form Camp Dates: June 19 th 23 rd (Must be filled in with a black pen or typed) FIRST NAME MIDDLE INITIAL LAST NAME PREFERRED NAME M F MAILING ADDRESS ADDRESS CITY STATE ZIP CODE COUNTY ETHNICITY WHITE BLACK HISPANIC ASIAN NATIVE AMERICAN OTHER BIRTH DATE AGE YOU WILL BE IN JUNE OF 2016 SOCIALSECURITY NUMBER HOME PHONE NUMBER MOTHER'S NAME JOB TITLE WORK PHONE NUMBER FATHER'S NAME JOB TITLE WORK PHONE NUMBER GUARDIAN'S NAME (IF APPLICABLE) JOB TITLE WORK PHONE NUMBER CLUBS AND/OR ORGANIZATIONS PARENTS/GUARDIANS ARE AFFILIATED WITH: NAME OF HIGH SCHOOL PHONE NUMBER CURRENT GRADE: FRESHMAN SOPHOMORE JUNIOR SENIOR G.P.A. NAME OF GUIDANCE COUNSELOR PHONE NUMBER LIST ANY OTHER RELEVANT ACTIVITIES (E.G., VOLUNTEER WORK) OR ACCOMPLISHMENTS (E.G., SCIENCE FAIR AWARDS): PLEASE USE A SEPARATE PIECE OF PAPER IF ADDITIONAL ROOM IS NEEDED. Do you have a current CPR Certification YES NO This student has my permission to apply to the 2016 Summer Health Careers Camp. Parent/Guardian Signature RETURN NO LATER THAN April 30, 2016 Jennifer Wolowitz, DHSc, MPH, CTTS

3 328 South Central Ave. Apopka, Florida Phone: (407) ext

4 3 Participant Application Form (continued) 1. I am most interested in learning about the following health care areas/careers: A) B) C) 2. Why are you interested in attending the 2016 Central Florida Area Health Education Center Summer Health Careers Camp? 3. Give three reasons why you would like to become a health care provider? 4. Describe the qualities you possess which make you an ideal candidate to become a health care provider.

5 4 Participant Application Form (continued) 5. All camper rooms are double or triple occupancy. Do you have any concerns about sharing a room? Yes No Please explain. 6. Please describe how you feel that you would benefit from this outstanding opportunity: 7. Please state any additional comments that you would like the selection committee to consider when reviewing your application:

6 5 REQUIREMENTS TO ATTEND CAMP Students must return all the following information with a completed application: 1) One recommendation, filled in completely and signed, from a Math, Science or Health Occupation Teacher. 2) One recommendation, filled in completely and signed, from an adult personal acquaintance or relative (other than immediate family members). 3) An official school copy of your last Mid-Term Grades.* 4) Official school transcript showing grades since the Ninth Grade*. *Have your guidance counselor attach a sealed transcript to your application. PERSONAL DISCLOSURE FORM Please advise us of any problem (i.e., summer job, child care, health condition, etc.) that you think might prevent you from attending the Summer Health Careers Camp. All information will be held strictly confidential and only qualified personnel will be dealing with these issues. We will do our very best to provide you with a workable solution that will enable you to attend. Please be very specific when stating the nature of your problem.

7 6 TEACHER'S RECOMMENDATION Name of Student: This student has applied to the 's (CF AHEC) Summer Health Careers Camp, The CFAHEC Camp was developed to help students, who may be interested in pursuing a career in health care, to get a more in-depth look at the various occupations available to them. Our main goal is to have these students become health care providers. It is our hope that, upon completion of their training, they will return to practice in the rural and under served areas around the state, where many of these students now live. Please be specific in your comments and answer all questions. 1. Please explain why you feel this student would benefit from this outstanding opportunity. 2. Do you feel this student is responsible? Please explain. 3. Can this student conduct himself/herself in a mature manner that will reflect well on the whole group? Yes No 4. Will this student act in a respectful manner to camp personnel? Yes No Teacher's Name (Please Print) Signature: Subject/Course Taught:

8 7 PERSONAL RECOMMENDATION Name of Student: This student has applied to the 's (CF AHEC) Summer Health Careers Camp, The CFAHEC Camp was developed to help students, who may be interested in pursuing a career in health care, to get a more in-depth look at the various occupations available to them. Our main goal is to have these students become health care providers. It is our hope that, upon completion of their training, they will return to practice in the rural and under served areas around the state, where many of these students now live. Please be specific in your comments and address all points. 1. Please explain why you feel this student would benefit from this outstanding opportunity. 2. Do you feel this student is responsible? Please explain. 3. Can this student conduct himself/herself in a mature manner that will reflect well on the whole group? Yes No 4. Will this student act in a respectful manner to camp personnel? Yes No Your Name (Please Print) Signature: Relationship to Student: