GMHC Training Application by 6wh5qW


									                       GMHC Training Application
                                           (revised as of February 17, 2012)

Name:                                                          Home Phone:
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In order to be eligible for the GMHC training, we require a minimum one-year volunteer commitment, after
completion of the training course. For our section, that means two Sunday clinic 6-hour shifts per month plus
another four hours of off-shift tasks per month (e.g. filing, filling out reports, entering results, cleaning, ordering
supplies, etc.).
Training will be every Sunday, starting January 25 . The GMHC offers two levels of training. The first level
involves training to be a paper worker and lab worker, which lasts about 5 weeks. The second level is to be a
medic and will last approximately 16 weeks, excluding Easter Sunday. Class will begin between 9am and 12pm,
depending on the week, and will finish by 2-3pm. Trainees are expected to stay for shift after class at least two
times a month. There may be (1-2) additional required classes. In addition to in-class education, you will be
expected to complete and turn in on-line training modules, which you will do on your own time.

If you know or even suspect that you cannot fulfill these requirements, please talk to a member of GMHC Training

If you commit to the requirements above please sign and date here:


You can email your completed application to, you can mail your completed
application to the GMHC Training Collective, Box C9, Berkeley Free Clinic, 2339 Durant Ave.,
Berkeley CA, 94704, or you can hand deliver it to the Berkeley Free Clinic, 2339 Durant Ave. We
will review applications in early January and get back in touch with you shortly thereafter
regarding the status of your application.
None of these questions are meant to trick you. We are not looking for specific answers, nor are we looking for a
specific “type” of person for these positions. We have a very diverse group of volunteers who are motivated to be
a part of our group for many different reasons, and we are interested to know what motivates you. Please answer
honestly, thoroughly, and to the best of your knowledge.

How long have you lived in the Bay Area and why did you come to the Bay Area?

How much longer do you plan to stay in the Bay Area (if there is a specific reason you may be leaving,
such as “I will be graduating,” or "I am applying to medical school," please state it)?
GMHC training application, page 2   Name: _______________________________

Why do you want to volunteer with the GMHC?

What do you hope to gain from your time volunteering with the GMHC, how will your involvement help

What part of our work is most interesting to you and what specific tasks (being a medic, working in the
lab, helping with intake) are you most interested in, and why?

What is your understanding of how the collective process functions? What do you see as the benefits
and drawbacks of working in a collective?

What do you believe are things you will bring or add to our Collective - how will your involvement help

Please describe your most enjoyable experience working with a team.
GMHC training application, page 3   Name: _______________________________

Please describe your least enjoyable experience working with a team.

Please cite an example of when you had to suspend your personal judgments or beliefs in order to
facilitate a constructive interaction with someone.

What concerns might you have about working with people with special situations such as homelessness,
HIV infection, or drug addiction? How could you manage these concerns?

As a medic, you will be asking detailed personal questions about an individual’s sexual practices, drug
use, or other risk behaviors in order to assess health needs. How would it make you feel having to
initiate conversations with straight and gay/bi men regarding these types of subjects?

Please describe your work experience.

Please describe your educational or training experience to date and future plans.
GMHC training application, page 4   Name: _______________________________

What other fabulous things should we know about you?

After the training, this form, the Skills / Evaluation Sheets, and any tests you take, go in a box on a high shelf in
the back storage room of the Berkeley Free Clinic where they will probably never see the light of day again unless
a state inspector or some legal proceeding requires us to show how we decided that you were competent to be a
medic at the Berkeley Free Clinic.

                            Releases / Informed Consent
There are health, social, and legal risks in being a medic, which are discussed as part of the training. We
consider these risks to be minimal, but they do exist. Being a volunteer medic will provide an exceptional
experience in health education and interviewing skills. You should fully understand what the risks are and weigh
them against the benefits volunteering with the GMHC may bring you.

Health risks include possible exposure to body fluids and contagious illnesses, including HIV and hepatitis.
Medics take rectal swabs, take urethral smears, culture lesions, handle urine specimens, and may do additional
training to draw blood. The training includes specific instruction and practice in how to take precautions with all
body fluids and protect against exposure.

Social risks include working with the homeless and the disenfranchised. We have had very little trouble over the
years, but we cannot guarantee that everyone will be well behaved. You will be doing physical exams of the
genitals of adult men of all sexual persuasions. You will be talking with these men about their sexual practices
and giving education on use of condoms and safe sex.

Legal risks are largely assumed by the clinic. Many clients are seen only by a lay medic trained by the clinic, and
not by the doctor. Medics work from standing orders given in advance by the doctor. Clinics do not usually
operate this way, but it does allow us to serve far more clients than we would otherwise be able to if a doctor had
to see every one. It also provides the medic a much more interesting, challenging and rewarding volunteer

You will be practicing all parts of the interview, physical examination, and taking of specimens on your classmates
as well as on other medics in the collective, and your classmates will be practicing on you. We believe that even
the poor and the homeless deserve to be seen by a medic who has already demonstrated his competence.

The Berkeley Free Clinic does not discriminate on the basis of age. Volunteers under the age of 18 may
participate on the same basis as those who are 18 and over. They must meet the same qualifications, must
complete the same training, and must demonstrate the same level of competence as the adults.



I have read all the above and have had all my questions answered to my satisfaction.

Signature ___________________________________________________ Date ________________

Parent/Guardian (if under 18) ____________________________________________ Date ________________

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