Evaluation must be completed within 48 hours of completing each service-learning experience.

Questions? Contact Suzette Roldan, Program Administrator, Post-Baccalaureate Certificate in Biomedical Sciences and Health Equity at sroldan@bcm.edu.

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* 1. Name

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* 2. BCM ID Number

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* 3. Service-Learning Experience Location

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* 4. Date of Experience

Date

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* 5. Number of Hours Completed

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* 6. Service-Learning Competencies

On a scale of 1 to 5 (where 1=strongly disagree and 5=strongly agree) please indicate your level of agreement with the following statements:

  1=Strongly Disagree 2=Disagree 3=Neutral 4=Agree 5=Strongly Agree
My service-learning experience reinforced my desire to become a healthcare professional (e.g., physician)
My service-learning experience provided me a better understanding about the impact healthcare professionals can have through service in improving health equity
My service-learning experience helped improve my awareness of the social determinants of health
My service-learning experience helped reaffirm my commitment to a service and advocacy orientation as a future healthcare professional
Overall, I was satisfied with my service-learning experience.
I would recommend this service-learning experience to other students.

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* 7. Describe the activities you engaged in on this particular date and how you believe they contribute to improving health equity or improving the social determinants of health.

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* 8. Select one of the prompts below to provide a 200-word summary of your Service-Learning Experience.

-  Why did you select this experience? How does it connect with your goal of becoming a medical / graduate healthcare professions student?

-  What unique aspects of service and advocacy did you observe or find to be available through this experience?

-  What knowledge, skills or abilities do you believe healthcare professions students and professionals can learn from this experience? If you have participated in prior service-learning experiences, compare and contrast.

-  How has this experience influenced/improved your interpersonal core competencies (service orientation, social skills, cultural competence, teamwork, and oral communication) for entering medical students?

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