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SOURCE (Student Outreach Resource Center)

HIV Application

Before completing the application to participate in SOURCE's HIV Counseling and Testing Program, be sure to carefully review all of the requirements for participation in the program (in pdf format). If you are unable to meet all requirements, please do NOT submit an application. You must be available to participate in all required training sessions listed for the program. Additionally, there will be other training/orientation sessions hosted by the participating community clinics themselves.

If you are able to commit to the participation requirements, you may now complete an application. Please note that the application deadline is Wednesday, September 10th by 11:59 pm. Additionally, the last few questions on the application require you to complete several short essay questions. You will need to create a separate Word or pdf document, and upload your responses. Please title your essay questions as "Your Last Name, Your First Name HIV Essay". Thank you.

 

Nursing Students! If you are an undergraduate nursing student, you must be enrolled in the School of Nursing's Community Outreach Program in order to participate in the HIV Counseling and Testing Program. Otherwise, please do NOT submit an application.
Will you be enrolled in school throughout the entire 2014-2015 academic year?*
Do you have access to a car for traveling to a clinic site?*
NOTE: Access to a car in NOT required, but it may be useful for some of our clinical sites.
Are you willing to utilize public transportation to access a clinical site?*
Are you able to make a minimum commitment of 2 shifts per month? (shifts are approximately 3-4 hrs in length)*
Are you able to commit to working in the HIV Program throughout the entire 2014-2015 academic year?*
Are you able to commit to attending and participating in quarterly reflection sessions?*
Are you available to work in the HIV Program during the Winter Break? This is not required, but clinics like to know the availability of our students.*
Are you available to work in the HIV Program during Summer 2015? This is not required, but clinics like to know the availability of our students.*
Which of the following participating community clinics would you be interested and available to participate in for the HIV Counseling and Testing Program? If selected to participate, you would be placed at just 1 location.
 
Would you like to be considered for HARRIET LANE CLINIC?*
Would you like to be considered for JHH EMERGENCY DEPARTMENT?*
Would you like to be considered for STAR?*
Would you be interested in serving as a Student Leader at one of the clinic sites? This entails working directly with the community clinic preceptor, scheduling volunteer shifts with the rest of the student counselors at your site (9 other students), troubleshooting, planning reflection sessions with your clinic and SOURCE, etc.*
Are you able to pay the $25 required training fee*
Do you agree to all outlined expectations and requirements of the HIV Counseling and Testing Program?*
In a separate document (Word or pdf files only please), please respond to the following 5 questions, and upload here. NOTE: You must Name your file "Your Last Name, Your First Name HIV Essay." You should also include your name in the header of your document on all pages. Documents without names on each page will not be considered for the program.
1. Describe previous community or health related experiences (especially with HIV/AIDS) - 1 paragraph.
2. Describe why you want to participate in the HIV Counseling Program. Please also describe your personal characteristics that you believe will contribute to your participation in the program and your career goals. - 1 paragraph
3. HIV Counseling work hours will be divided into several shifts (mornings, afternoons, evenings, and weekends). Though these shifts may be flexible, do you have any potential or known time conflicts?
4. During the upcoming academic term this Fall, please list all available days and times that you would be available to volunteer (include Monday through Sunday, morning through evening hours). We are aware that your available times will change, but the clinics would like to get a sense of the availability of our student applicants.
5. Any other things that you would like the selection committee to know about you or your possible participation in the program (max 1 paragraph)