Summer of Service Application

Application 2015

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

Question Title

* 1. Your name

First:

Last:

Question Title

* 2. How interested are you in the following placement opportunities? (Details available on website)

	Very	Somewhat	Little	Not
Edward M Kennedy Family Health Center – community health worker training kit	Edward M Kennedy Family Health Center – community health worker training kit Very	Edward M Kennedy Family Health Center – community health worker training kit Somewhat	Edward M Kennedy Family Health Center – community health worker training kit Little	Edward M Kennedy Family Health Center – community health worker training kit Not
Family Health Center Worcester – hypertension project	Family Health Center Worcester – hypertension project Very	Family Health Center Worcester – hypertension project Somewhat	Family Health Center Worcester – hypertension project Little	Family Health Center Worcester – hypertension project Not
Mosaic Cultural Complex and Hector Reyes House – health education & IT	Mosaic Cultural Complex and Hector Reyes House – health education & IT Very	Mosaic Cultural Complex and Hector Reyes House – health education & IT Somewhat	Mosaic Cultural Complex and Hector Reyes House – health education & IT Little	Mosaic Cultural Complex and Hector Reyes House – health education & IT Not
Worc. Div of Public Health - safe prescribing project	Worc. Div of Public Health - safe prescribing project Very	Worc. Div of Public Health - safe prescribing project Somewhat	Worc. Div of Public Health - safe prescribing project Little	Worc. Div of Public Health - safe prescribing project Not
Worc. Div of Public Health - overdose prevention projects	Worc. Div of Public Health - overdose prevention projects Very	Worc. Div of Public Health - overdose prevention projects Somewhat	Worc. Div of Public Health - overdose prevention projects Little	Worc. Div of Public Health - overdose prevention projects Not
Worcester Refugee Assistance Project - summer youth program assistant coordinator	Worcester Refugee Assistance Project - summer youth program assistant coordinator Very	Worcester Refugee Assistance Project - summer youth program assistant coordinator Somewhat	Worcester Refugee Assistance Project - summer youth program assistant coordinator Little	Worcester Refugee Assistance Project - summer youth program assistant coordinator Not
Other placement- self-defined	Other placement- self-defined Very	Other placement- self-defined Somewhat	Other placement- self-defined Little	Other placement- self-defined Not

Other (please specify)