2020 Summer of Service Application

Application 2019

Thank you for your interest in the Summer Community Health Assistantship. Please answer the following questions to aid us in selection and placement of students into community settings.

Question Title

* 1. Contact information

First name:

Last name:

Cell phone #

Preferred email

Question Title

* 2. Some of our community partners have identified specific needs or projects for which they would appreciate support. How interested are you in the following defined placement opportunities? (Note: You will also have opportunity for open-ended responses on the next page.)

	Very	Somewhat	Not
Worcester Public School Nursing: Flu Clinic	Worcester Public School Nursing: Flu Clinic Very	Worcester Public School Nursing: Flu Clinic Somewhat	Worcester Public School Nursing: Flu Clinic Not
Worcester Healthy Baby Collaborative: Baby Boxes	Worcester Healthy Baby Collaborative: Baby Boxes Very	Worcester Healthy Baby Collaborative: Baby Boxes Somewhat	Worcester Healthy Baby Collaborative: Baby Boxes Not
Worcester Healthy Baby Collaborative: Breastfeeding Education (bilingual w Spanish)	Worcester Healthy Baby Collaborative: Breastfeeding Education (bilingual w Spanish) Very	Worcester Healthy Baby Collaborative: Breastfeeding Education (bilingual w Spanish) Somewhat	Worcester Healthy Baby Collaborative: Breastfeeding Education (bilingual w Spanish) Not
Worcester Refugee Assistance Project	Worcester Refugee Assistance Project Very	Worcester Refugee Assistance Project Somewhat	Worcester Refugee Assistance Project Not
Palliative Care	Palliative Care Very	Palliative Care Somewhat	Palliative Care Not
Jana's House (for women in recovery w history of sex trafficking)	Jana's House (for women in recovery w history of sex trafficking) Very	Jana's House (for women in recovery w history of sex trafficking) Somewhat	Jana's House (for women in recovery w history of sex trafficking) Not