Use this form to indicate your preferences for team placement. Full descriptions of all the teams are available at
http://www.umassmed.edu/uploadedFiles/fmch/Community_Health/PHC2013_Team%20Directory040513.pdf
Students in the Clinical and Translational Research Pathway and those who are in the Rural Health Scholars Pathway are pre-assigned to teams specific to those programs (Teams 6, 13, and 23). If you are in one of those programs, you do not need to complete this ranking exercise. If you are unsure, speak to Dr. Upshur (CTRP) or Dr. Cashman (RHSP)

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* 1. Name:

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* 2. I am a

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* 3. Please indicate your top five choices.

  First Second Third Fourth Fifth
1. ACTION Health Services North County, Fitchburg
2. Adolescent Obesity in Rural Settings, Barre
3. Barnstable County Behavioral Health Care, Barnstable
4. Caring for Adults with Intellectual Disabilities, Worcester/ Waltham/ Springfield
5. Children’s Mental Health, Worcester/ Boston
7. End of Life Care, Worcester
8. Fire related injuries in older adults smoking while on Long Term Oxygen Therapy (LTOT), Carlisle
9. Geriatrics: Health Issues for Older Adults, Worcester
10. Ghanaian Women’s Health, Worcester
11. Head Start, Worcester
12. Health Care for the Homeless, Worcester
14. Implementing State and National Health Policy, Worcester
15. Latinos Living with HIV – Northern MA, Lawrence
16. Latinos Living with HIV – Southern MA, New Bedford
17. LGBT Health, Homophobia & Heterosexism, Worcester/Boston
18. Living with Disabilities, Worcester
19. Lowell Community Health Center: Culturally Sensitive Care, Lowell
20. More than an ounce of prevention: Programs to prevent injury from trauma in all age groups, Worcester
21. Parenting & Family Stability, Worcester
22. Refugee Mental and Physical Health, Worcester
24. Urban Working Poor and Incarcerated , Jamaica Plain
25. Veterans’ Health, Worcester/Boston/Bedford
26. Worcester Department of Public Health, Worcester
27. Worcester’s Faces and Places: Family Health Center Worcester, Worcester

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* 4. Comments?

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