Health and Medical Sciences 98/198: The Suitcase Clinic

A Service Learning Course

www.suitcaseclinic.org

 

COURSE APPLICATION

Legibly print all of the requested information in the space provided below.  Applications are due by 4:00 PM Wednesday, January 30th, in 570 University Hall. We will not accept any late applications.

 

Last Name: __________________________________   First Name: ____________________________

SID: ____________________________________   Graduation Semester and Year: _______________

Primary e-mail address: ______________________________________________________________

Phone number(s): ____________________________   Major(s): ______________________________

Career Plans: ________________________________________________________________________

HMS 98/198 will be held every Thursday from 5:00 - 7:00 PM in 56 Barrows Hall. You must also be available on either Monday or Tuesday nights after 6:00 PM to volunteer at one of our drop-in centers.

 

1.  Are you willing to take HMS 98/198 next semester if you are not admitted to participate in this semesterÕs course?

            YES  /  NO

2.  Have you previously applied for HMS 98/198?

            YES  /  NO

3.  How did you hear about the Suitcase Clinic and HMS 98/198?

 

 

4.  Do you have a car? (Some small groups benefit from the availability of cars to transport supplies)

YES  /  NO

 

A mandatory part of the curriculum for HMS 98/198 is participating in a small group project.  Please rank the following from #1-6, #1 being your most preferred. These rankings will help determine your small group for the semester if you are admitted, but will have no effect on your acceptance into the class:

 

Youth  Clinic                                                   _____

WomenÕs Clinic                                              _____

Unity                                                                _____

Dinners                                                          _____

Supply Drive                                                  _____                                     

Survey                                                             _____

*Note that the Dinners, Supply Drive, Unity and Survey small groups will have volunteers participating primarily at the General Clinic drop-in center. Consult the syllabus for group descriptions.

Please provide thoughtful responses to the following questions.  You may choose to answer these questions on a separate page and staple it to this application with your full name on it.  There are no wrong answers and we value diversity of opinions.

1. Why are you interested in taking this course and volunteering with the Suitcase Clinic?

 

 

 

 

 

 

 

2.  How do you regularly respond to people on the street who ask you for money?

 

 

 

 

 

 

 

3.  When involved with a group project, what personal qualities do you contribute in order to help ensure its completion?

 

 

 

 

 

 

 

4.  What are the most important issues homeless individuals face today?

 

 

 

 

 

 

 

5.     Explain your small group preferences and/or any special circumstances we should be aware of.

 

 

 

 

 

 

 

 

 

Application Checklist

For All Applicants

_____Tuesday Jan 29th General Clinic Tour

_____Completed applications to 570 University Hall by 4PM Wed, Jan 30th

For WomenÕs Small Group Applicants

_____Monday Jan 28th WomenÕs Clinic Tour

For Youth Small Group Applicants

­­­­­_____Monday Jan 28th Youth Clinic Tour