HCOP Summer Camp Application

Are you interested in exploring health profession careers? Do you want to spend time at a university for an overnight camp?

Join us this summer for a six-week Summer Program from July 9th - August 15th, 2024. You will have an opportunity to shadow in healthcare related fields in areas like Physician Assistant, Registered Dietitian, Physical and Occupational Therapy, Pharmacy, Psychology, Community Health Workers, Radiologic Technologist, EMT/Paramedic and Social Work.

You will participate in activities to enhance your academic skills and understand more about the health needs in our community. You will be able to shadow a health professional in your area of interest and spend time at D’Youville University at an overnight camp.

This is a PAID Position for High School Students.

Eligible students will be:

Rising sophomores, juniors and seniors (as of September 2024)
Reside and attend school in the following counties; Allegany, Cattaraugus, Chautauqua, Genesee, Livingston, Monroe, Ontario, Orleans, Steuben, Wayne, Wyoming and Yates.
Interest in the healthcare field

Complete this form to submit your application. Your application won’t be submitted until you click the “Done” button at the end of this form.

Once your application has been submitted, we will reach out to you and set up a brief virtual interview.

All applications must be submitted on or before Monday, May 6th, 2024.

For questions please email: info@r-ahec.org

phone: (585)786-6275

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* 1. Contact Information

First Name:

Last Name:

Address:

City/Town:

State:

Zip Code:

County:

Personal Email:

Cell Phone Number:

Parent/Guardian Name:

Parent/Guardian Phone Number:

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* 2. Personal Information:

Preferred Name (if different):

Preferred Pronouns:

Date of Birth:

Age by September 2024:

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* 3. Emergency Contact Information

Name:

Phone Number:

Relationship:

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* 4. Which best describes your RACE?

African American/Black

Asian

Native American: Indian/Alaskan

Native Hawaiian/Other Pacific Islander

White

Other

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* 5. Are you Hispanic or Latino?

Yes

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* 6. What is your gender?

Female

Male

Prefer not to answer

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* 7. Do you have any food or dietary restrictions? (For example nut allergies, vegan, vegetarian) If yes, please explain.

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* 8. Considering housing, would you require no-cost housing during the HCOP Summer Program?

Yes

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* 9. What is your T-shirt size?

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* 10. To participate in the program working papers are required. Do you currently have your working papers?

Yes

To qualify for the summer program you may identify as economically in need. Please answer the following question to the best of your ability.

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* 11. My family qualifies for public assistance.

Yes

I don't know

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* 12. Did either of your parents attend college?

Yes

I don't know

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* 13. Name of school currently attending?

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* 14. What type of school do you currently attend?

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* 15. in the 2024-2025 school year, what grade will you be in?

10th

11th

12th

9th

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* 16. What is your current GPA?

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* 17. How did you hear about this opportunity?

Please answer the questions below. Each response should not exceed 100 words.

Responses do not have to be perfect, but should reflect your personality, interests and background to allow us to get to know you a little bit.

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* 18. Why are you interested in being part of HCOP Summer Program?

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* 19. What health careers are you interested in? Why?

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* 20. What characteristics and personality traits identify you? How would you describe yourself to a stranger?

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* 21. How do you think being part of this program would help you with your future goals?

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* 22. What do you want to learn from the HCOP Summer Program?

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* 23. Considering transportation, how will you get to the HCOP Summer Program sessions and D'Youville University overnight camp? Do you have transportation issues that you may need assistance with?

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* 24. Do you have any questions or concerns you would like us to address?

Please read and check both statements below to verify agreement.

I understand that:

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* 25. If I am under the age of 18, my parent/guardian's permission will be required if I am hired:

Yes

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* 26. By checking this box, I am promising that all the information in this application is true:

Yes