Health Equity Scholars 2021-2022 Application

Email

Name of Employer:

Year of Graduation from Clinical Program

If you indicated "other", please specify

How many years have you been working in this health professions role?

Please indicate your degrees and the years they were completed:

What State do you work in?

What town/city do you work in?

If you indicated "other", please specify

Describe the populations you serve as a clinician and health equity advocate

e.g. LGBTQ, BIPOC, incarcerated, Medicaid insured

If you use pronouns that are not listed and would like to let us know what they are, please do so below

If you do not identify with any of the above genders and would like to tell us how you identify, please do so below.

If you do not identify as any of the above sexual orientations and would like to tell us how you identify, please do so below:

If you don not identify as any of the above and would like to tell us how you identify, please do so below:

If there is anything else you would like to share about your identities, please do so below

The tuition for the Health Equity Scholars Program is $4,000. Our expectation is that institutions will sponsor scholars to participate in this program for their enrichment and for the project that will be developed to support the institution. We recognize that not all institutions will commit to do this and therefore we will provide some scholarships every year.

If yes, please provide the name of your supervisor

If you answered "other", please elaborate below

Time Commitment

The Mid-career scholars will be expected to: • Attend Online Launch Workshop (two 3-hour sessions) • Participate in the online curriculum, that includes monthly online two-hour sessions, • Peer coaching and group sessions (approx. 1 hour/month) • Develop and lead an advocacy project within their organization/community • If attending in person is possible, in-person attendance of final gathering.

If you answered unsure, please describe

About You

What inspired you to apply for the health equity scholars course? What do you hope to gain from this program? Please include any relevant health equity/advocacy work you have participated in and/or are passionate about. (Approximately 500 words)

Advocacy project

All Health Equity Scholars are required to submit a description of a specific advocacy action/project. The project should be an ongoing or potential project that relates to health equity. Scholars will be selected based on a demonstrated commitment to health equity and the potential to lead advocacy activities in the future.

Please describe the project you would like to design and implement within your institution or your community. In your response, address how this project will address key health equity issues and the community/patient/staff populations this project will seek to support. (Approximately 500 words)

Health Equity Scholars Program Application

Cambridge Health Alliance

Center for Health Equity Education and Advocacy