Zuckerberg San Francisco General Hospital’s Community Wellness Program was initiated in 2011 to provide wellness opportunities for our community of patients, staff and community members. We take a holistic approach and strive to tailor our program to meet the needs of our medically underserved patient population and the providers and staff who care for them. Your role will vary depending on your background, interests and our needs, but will often include the following:
• Provide administrative and logistical support for all operations of the Wellness Center.
• Supports outreach efforts to engage underserved and often hard to reach patients and staff.
• Assists with program evaluations and assessments through surveys and focus groups to ensure that the program delivers quality programs and services.
• Serve as a liaison with hospital and community groups to support programs that engage participants through innovative strategies and incentives.
• Supports health promotion activities including workshops, lectures and classes on a variety of health and wellness topics, including nutrition, diabetes management, tobacco cessation, stress reduction, etc.
• Assist with community outreach events at the hospital and in the community.

ZSFG’s Community Wellness Program is located on the 2nd floor of Zuckerberg San Francisco General in room 2D35.
Name:

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* 1. Name:

Address:

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* 2. Address:

Phone Number:

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* 3. Phone Number:

Email Address:

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* 4. Email Address:

Date of Birth:

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* 5. Date of Birth:

Gender:

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* 6. Gender:

Emergency Contact
Emergency Contact Name:

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* 7. Emergency Contact Name:

Work Phone:

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* 8. Work Phone:

Cell Phone:

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* 9. Cell Phone:

Availability: The Community Wellness Center operates Monday-Friday from 9am-5pm, with few evening classes/workshops/support groups. Please provide us with the length of commitment and your current availability that you can commit to for the duration of your internship or volunteerism.
Length of Commitment

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* 10. Length of Commitment

Provide the Days/Times you are available.

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* 11. Provide the Days/Times you are available.

Academic Institution:

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* 12. Academic Institution:

Major/Field of Study:

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* 13. Major/Field of Study:

How did you learn of San Francisco General Hospital’s Community Wellness Program? What do you know about our program?

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* 14. How did you learn of San Francisco General Hospital’s Community Wellness Program? What do you know about our program?

Describe your interest and/or background in working in a public health environment with medically under-served populations.

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* 15. Describe your interest and/or background in working in a public health environment with medically under-served populations.

What areas of wellness interest you? What do you hope to gain from working with us?

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* 16. What areas of wellness interest you? What do you hope to gain from working with us?

We will do our best to assign you to projects based upon your interest and need. Please select your top two areas of interest:

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* 17. We will do our best to assign you to projects based upon your interest and need. Please select your top two areas of interest:

What specific skills & qualifications can you bring to San Francisco General Hospital’s Community Wellness Program?

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* 18. What specific skills & qualifications can you bring to San Francisco General Hospital’s Community Wellness Program?

Describe your work style. Do you prefer working individually or as part of a team?

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* 19. Describe your work style. Do you prefer working individually or as part of a team?

How comfortable are you interacting with the public?

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* 20. How comfortable are you interacting with the public?

What questions do you have for us?

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* 21. What questions do you have for us?

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