| The
Basics |
| Name: |
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| Major: |
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| Campus Box: |
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| Cell: |
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| Campus Address: |
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| Assigned Faculty
Advisor: |
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Name of Trinity faculty
member who would be willing to discuss your qualifications for this
program with
the Health Fellows faculty: |
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| Academics/Experience |
1. Indicate your current
grade point average: |
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2. What was your
favorite
course and why? |
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| 3. Describe any
research experience you have had, and with whom: |
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| 4. Describe any of
your volunteer or work experience that may be pertinent to your work
as a Health Fellow: |
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| 5. Areas of
healthcare in which you already have an interest, if any: |
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| 6. Have you thought about what your career plans might be after graduating Trinity? If so, what are they?: |
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7. Which of the
following method(s) of transportation would you have access to in
order to get to your placement?
(check all that apply) |
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| 8. We offer placements
in three different settings. Although there is no guarantee
where you will be placed, please rank in order of preference, (if
any), where you would like to conduct research: |
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Laboratory-Based Research | |
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Hospital-Based Research | |
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Clinic-Based Research | |
| ** Please be aware that IF you are
accepted into the program, your supervisor/mentor may be one of the
following: a physical therapist, occupational therapist, speech
therapist, nurse, dietician, social worker, doctor, physician
assistant, or Ph.D. |
| 9. If we are not able to accommodate your
primary choice or area of interest, would you still be willing to
participate in the program? |
Yes
No |
10. Initials - By initialing this,
you have indicated that you understand the terms of the Health
Fellows Program, that is, if accepted into the program, you will
participate in both the placement AND seminar.
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11. Lastly, please write a 1-page essay on your reasons for
wanting to participate in the Health Fellows Program and copy and
paste this essay into the text field to the right.
| DO NOT try to compose your essay in the field to the
right. If your browser crashes, you will lose all of your
work. |
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