Teen Educator Application

PAID ($$$) Position for High School Students

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

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* PATCH stands for Providers and Teens Communicating for Health. For more information about the program, please visit <www.patchprogram.org>.

PATCH @ WNY Rural, a program run by Western New York Rural Area Health Education Center (WNY R-AHEC), believes that health care practices, programs, and policies should be developed WITH young people rather than just FOR them.

For questions, contact Heidi Baker: Email: <hbaker@r-ahec.org> or call (585)786-6275.

Applications Due: Saturday, September 30th

In this program, we rely on YOU to be the expert and share what you know about being a teen, like:

What are you and your peer’s concerns about heath & healthcare?

What are things that make you comfortable or uncomfortable accessing healthcare services?

How much do you or your peers know about your healthcare rights as a teen?

Where do you and your peers find health information?

Do you agree to the importance of these topics for teens?

Agree

Disagree

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* Contact Information

First Name *

Last Name

Address *

City/Town *

State *

ZIP Code *

Mailing Address (write "same" if not different)

WNY county of residence: *

Home Phone Number *

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* Personal Information:

Preferred Name (if different):

Preferred Pronouns:

Date of Birth:

Age by September 2024:

Personal Email Address (must have a non-school related email address to apply).

Personal Cell Number:

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* Are you Hispanic or Latino?

Yes

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* Which best describes your RACE?

African American/Black

Asian

Native American: Indian/Alaskan

Native Hawaiin/Other Pacific Islander

White

Other

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* What is your gender?

Female

Male

Other (specify)

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* Parent/Guardian Information:

First Name: *

Last Name:

Cell Number: *

Emergency Contact: *

Emergency Phone #: *

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* What is your preferred method of contact?

Personal Email

Text my personal cell number

Text my parent/guardian cell number

Call my home phone

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* What is your backup method of contact?

Text my personal cell number

Text my parent/guardian cell number

Call my home phone.

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* Anything else you would like us to know about you?

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* In 2024-2025 school year, what grade will you be in?

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* What school do you attend? (Please state homeschool, private, public, charter, or online).

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* How did you hear about this opportunity?

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* What is your T-shirt size?

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* Written Response Questions

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 better.

1. Why are you interested in being part of PATCH?

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* 2. What is your interest level in the healthcare field? What potential healthcare careers are you considering?

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* 3. What health-related topic(s) are of high interest to you? Why?

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

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* 5. What are the two most important health-related issues for teens in your community? What do you think should be done to address these issues?

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* 6. What do you think adults and health care providers (like doctors and nurses) should know when talking with teens about challenging health topics (like mental health, sexual health, drug or alcohol use)?

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* 7. What skills, knowledge, experiences, or passions do you have that you think will make you a successful Teen Educator?

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* 8. What does advocacy mean to you? How would you use this position to advocate for others?

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* 9. What unique perspectives do you think you would bring to this team based on your identities and life experiences?

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* 10. How do you think being part of this program would help you with your future goals? What do you want to learn from PATCH?

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* 11. Considering transportation, how will you get to Educator Training, enrichment meetings, and workshops? Do you have any transportation issues that you may need assistance with?

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

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* Confirmation of Application

Please review all the expectations below and check the box for each of them before submitting your application.

Commit to this position for the whole program year.

I agree to attend all mandatory, in-person training during for the following dates/days/times:
Oct. 2nd & 5th (In-Person Interviews from 4:00-7:00 PM)
November 2nd, 4th, 9th, 16th, & 18th (Required Teen Educator Training Dates)
Two Thursday evenings per month (Required Teen Enrichment Meetings).

Participate in evening in-person meetings two times each month (usually every other Thursday).

Find transportation to and from all workshops and meetings (some travel assistance may be available).

Be in regular contact with program coordinator via email, text or other modes of communication.

Represent myself, my school, and the organization responsibly.

Be respectful of my fellow team members, supervisor, and other individuals involved in the program.

Be open-minded and excited about working with people who may be different from myself.

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* Please read & check both statements below to verify agreement.
I understand that:

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

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

Teen Educator Application

PAID ($$$) Position for High School Students

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* Contact Information

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* Personal Information:

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* Are you Hispanic or Latino?

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* Which best describes your RACE?

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* What is your gender?

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* Parent/Guardian Information:

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* What is your preferred method of contact?

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* What is your backup method of contact?

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* Anything else you would like us to know about you?

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* In 2024-2025 school year, what grade will you be in?

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* What school do you attend? (Please state homeschool, private, public, charter, or online).

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* How did you hear about this opportunity?

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* What is your T-shirt size?

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* 2. What is your interest level in the healthcare field? What potential healthcare careers are you considering?

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* 3. What health-related topic(s) are of high interest to you? Why?

Question Title

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

Question Title

* 5. What are the two most important health-related issues for teens in your community? What do you think should be done to address these issues?

Question Title

* 6. What do you think adults and health care providers (like doctors and nurses) should know when talking with teens about challenging health topics (like mental health, sexual health, drug or alcohol use)?

Question Title

* 7. What skills, knowledge, experiences, or passions do you have that you think will make you a successful Teen Educator?

Question Title

* 8. What does advocacy mean to you? How would you use this position to advocate for others?

Question Title

* 9. What unique perspectives do you think you would bring to this team based on your identities and life experiences?

Question Title

* 10. How do you think being part of this program would help you with your future goals? What do you want to learn from PATCH?

Question Title

* 11. Considering transportation, how will you get to Educator Training, enrichment meetings, and workshops? Do you have any transportation issues that you may need assistance with?

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

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* Confirmation of ApplicationPlease review all the expectations below and check the box for each of them before submitting your application.

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* Please read & check both statements below to verify agreement.I understand that:

* Confirmation of Application

Please review all the expectations below and check the box for each of them before submitting your application.

* Please read & check both statements below to verify agreement.
I understand that: