The Mobile Clinic Project at UCLA Academic Year 2014-2015 Ca e !

or"er A##lication
Yo$ can "ee# thi in%ormation heet %or &o$r re%erence' Plea e do not ret$rn thi in%o heet (ith &o$r a##lication'

)e cri#tion* The Mobile Clinic Project at UCLA is a student-run, street-based program that provides social and health services to the homeless population of Holl !ood"#est Holl !ood$ This interdisciplinar project involves undergraduates that serve as case!or%ers, medical students that oversee the clinic and health services, ph sicians !ho are consulted, public health students !ho oversee assist !ith the referral and follo!-up of clients, and la! students !ho provide legal aid$ The MCP +er,ice Learnin- Under-rad$ate Trainin- +e ion !ill meet on .rida& a%ternoon / tentati,el& %rom 1-4#m on cam#$ $ &e! case!or%ers must attend the entire three hours$ This class is not offered for units for fall 'uarter( ho!ever, the mandator service learning sessions !ill be taught b professionals$ #inter and spring 'uarters !ill both be offered for unit credit$ )ervice learning !ill offer student case!or%ers immediate opportunities to gain the s%ills necessar to support and enhance their performance at clinic$ *nterested students are e+pected to participate in Mobile Clinic for all three 'uarters and in the summer$ After a full academic ear, students can voluntaril case!or% at their o!n !ill$ The clinic operates !edne da& e,enin- %rom 4*00-1#m and +at$rda& mornin- %rom 2*45am-12#m ,but please note that students !ill be rotating Clinic nights throughout the 'uarter and should e+pect to serve as case!or%er --. times per 'uarter A&/ heavil during the summer0$ *n class, students !ill learn about health and social problems affecting our target population, discuss !a s of improving services, and !ill be responsible for ongoing group projects ,!ith their committee members0 designed to complement the project1s operational aspects$ *t is also re'uired that all students regularl serve food to our clients !ith the 2reater #est Holl !ood 3ood Coalition one night a !ee% throughout both 3all and #inter 'uarters$ The second component of the course ta%es place in the field, !here students are re'uired to complete a minim$m o% 50 ho$r o% %ield(or" o$t ide o% cla ,average of . hours"!ee%0$ The hours can be completed b !or%ing on our assigned group project, !or%ing at the clinics, net!or%ing !ith other organi4ations that can offer services to our clients, and b going out to the clinic site to help distribute food to our clients$ 2rading criteria includes class attendance and participation, field!or% and evaluation, !ee%l journals, committee involvement and final group project"presentation$ 5ou !ill be e+pected to schedule and attend regular committee meetings$ Ca e (or"er conduct social histories during client inta%e, serve as the client1s advocate, and assist them in various capacities in the clinic and refer them to social services the ma be entitled to$ *n addition, ou !ill be re'uired to go to the site at 678. pm on an a i-ned ni-ht of the !ee% to help distribute food to our clients$ )tudents are also re'uired to assist !ith operational tas%s related to the project$ 3n tr$ction to a##licant * This course is offered to UCLA undergraduate students of all majors$ 2raduate and professional students can also appl to be case!or%ers7 just note our status on the application$ Please note that the number of students !e can accept in the class is limited$ Please complete and email this application b Friday, May 2nd, 2014 at midnight to7 mcpapplication1415@gmail.com' )end application as a Microsoft #ord attachment$ Applications !ith missing information !ill not be considered$ 4arl& a##lication are hi-hl& enco$ra-ed a (e are cond$ctin- inter,ie( on a %ir t come %ir t er,e ba i ' 5ou ma be contacted via email or phone b a coordinator to schedule an intervie!$

Application ,Mobile Clinic Project at UCLA0 3' 5eneral 3n%ormation

Major7 9999999999999999999999999999 UCLA */ ;999999999-99999999-99999999 ; units completed ,end of )pring 8<099999 2$P$A$ in Major7 999999 Are ou a transfer student from another school> 9995 999&

&ame7 999999999999999999999999999 /ate of :irth7 9999"9999"999Career 2oal7 99999999999999999999999 )e+7 999M 9993 5ear in )chool7 999999 =verall 2$P$A$7 999999

*f transfer7 *nstitution7 9999999999999999999999 Units completed7 9999999 /ates attended7 9999999999999999 ?mail7 999999999999999999999999999999999999999999999999999999999 PL?A)? CH?C@ 5=UA ?MA*L #??@L5 3=A UP/AT?/ C=UA)? *&3= Current Address7 99999999999999999999999999999999999999999 99999999999999999999999999999999999999999 Phone7 ,9999990999999999999999999999999999 Permanent Address7 9999999999999999999999999999999999999999999 9999999999999999999999999999999999999999999 Phone7 ,999999099999999999999999999999999999

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6$ic" 6$e tion

Please list all the courses or relevant e+perience that helped prepare ou to serve as a case!or%er assisting homeless persons ,note7 these don1t have to be science classes0$ *nclude courses from an department, e+tra-curricular !or%, research, volunteer activities, internships, !or% e+perience, other languages spo%en"!ritten, etc$ &ame all other organi4ations"jobs ou are currentl involved in$ Please list and include an estimate of hours spent per !ee% on each$ #hat are our plans for this coming summer> #ill ou be in the #est!ood area> Ho! man more ears of school do ou have> Can ou fluentl spea% and"or !rite in an foreign languages> /o ou currentl hold an leadership positions> :riefl describe our time commitments for the )ummer as !ell as the upcoming ear$ #ill ou have a car ne+t ear> Are ou !illing to drive it to clinic>

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Please ran% the follo!ing committees in the order of our preference ,8-most desired, 6-least07 F+ee MCP (eb ite 7((('mc#'$cla'ed$8 or attend in%o e ion %or detailed de cri#tion o% each committee' /atabase Aeferrals 2rant!riting 999999 999999 999999 Health ?d =utreach #e-Ho Logistics 999999 999999 999999

FPlease provide a short e+planation for our primar committee preference

3' +hort An (er Please briefl respond to the follo!ing 'uestions$ 5our responses should be specific and concise$ 5our ans!ers are an e+tremel important part of the selection process$ 8$ Ho! did ou hear about the Mobile Clinic Project at UCLA> Ho! !ill this course"program fit into our academic"!or%"e+tra-curricular activit load for the upcoming academic ear> #hat is our current relationship or past e+perience in !or%ing !ith the medicall indigent, homeless, and generall underserved populations> #hat interests ou most about !or%ing !ith the homeless"lo! income and !h do ou !ish to get involved> #hat do ou e+pect to gain from our participation in the Mobile Clinic Project at UCLA> #hat do ou thin% ou can contribute to the student-run program and to the lives of those clients served> *f ou had t!o minutes to send the entire !orld a message, and ever one !ould listen, !hat !ould ou sa > Ho! !ould ou deliver our message>

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39' )e-ree Pro-re :e#ort 7)P:8 G Please attach our degree progress report, this can be found on !!!$ursa$ucla$edu$ ,onl include courses ta%en, 2PA, number of units completed0 G PLEASE DO NOT attach full DPR$