CHS 195 � �Field Studies in Cancer Control�

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					                          “ The Mobile Clinic Project at UCLA”
                     Academic Year 2012-2013 Case Worker Application
                 You can keep this information sheet for your reference.
                   Please do not return this info sheet with your application.

                                            Description:
The Mobile Clinic Project at UCLA is a student-run, street-based program that provides social
and health services to the homeless population of Hollywood/West Hollywood. This inter-
disciplinary project involves undergraduates that serve as caseworkers, medical students that
oversee the clinic and health services, physicians who are consulted, public health students who
oversee assist with the referral and follow-up of clients, and law students who provide legal aid.
The MCP Service Learning Undergraduate Training Sessions will meet on Friday
afternoons, tentatively from 1-4pm on campus. New caseworkers must attend the entire three
hours. This class is not offered for units; however, the mandatory service learning sessions will
be taught by professionals. Service learning will offer student caseworkers immediate
opportunities to gain the skills necessary to support and enhance their performance at clinic.
Interested students are expected to participate in Mobile Clinic for all three quarters and in the
summer. After a full academic year, students can voluntarily casework at their own will.
The clinic operates Wednesday evenings from 4:30-9pm and Saturday mornings from
8:30am-12:30pm (but please note that students will be rotating Clinic nights throughout the
quarter and should expect to serve as caseworker 3-5 times per quarter AND heavily during the
summer). In class, students will learn about health and social problems affecting our target
population, discuss ways of improving services, and will be responsible for completing a group
project (with their committee members) designed to complement the project’s operational
aspects. It is also required that all students regularly serve food to our clients with the Greater
West Hollywood Food Coalition one night a week throughout both Fall and Winter quarters.

The second component of the course takes place in the field, where students are required to
complete a minimum of 50 hours of fieldwork outside of class (average of 5 hours/week). The
hours can be completed by working on your assigned group project, working at the clinics,
networking with other organizations that can offer services to our clients, and by going out to the
clinic site to help distribute food to our clients. Grading criteria includes class attendance and
participation, fieldwork and evaluation, weekly journals, committee involvement and final group
project/presentation. You will be expected to schedule and attend regular committee meetings.
Case workers conduct social histories during client intake, serve as the client’s advocate, and
assist them in various capacities in the clinic and refer them to social services they may be
entitled to. During the weeks students aren’t signed up to volunteer at the clinic, you will be
required to go to the site at 6:15 pm on an assigned night of the week to help distribute food to
our clients. Students are also required to assist with operational tasks related to the project.

                                   Instructions to applicants:
This course is offered to UCLA undergraduate students of all majors. Graduate and professional
students can also apply to be caseworkers: just note your status on the application. Please note
that the number of students we can accept in the class is limited.
Please complete and email this application by Friday, May 4, 2012 at midnight to:
mcpapplication1213@gmail.com. Send application as a Microsoft Word attachment.
Applications with missing information will not be considered. Early applications are highly
encouraged as we are conducting interviews on a first come first serve basis. You may be
contacted via email or phone by a coordinator to schedule an interview.
                            Application (Mobile Clinic Project at UCLA)

I.      General Information
Name: ___________________________ Date of Birth: ____/____/___ Career Goal: _______________________
Sex: ___M ___F           Major: ____________________________ UCLA ID #_________-________-________
Year in School: ______            # units completed (end of Spring 12)_____
Overall G.P.A.: ______   G.P.A. in Major: ______    Are you a transfer student from another school? ___Y ___N
If transfer: Institution: ______________________ Units completed: _______ Dates attended: ________________
Email: ______________________ ___________________________________
PLEASE CHECK YOUR EMAIL WEEKLY FOR UPDATED COURSE INFO
Current Address:                                           Permanent Address:
_________________________________________                  ___________________________________________
_________________________________________                  ___________________________________________
Phone: (______)___________________________                 Phone: (______)_____________________________
II.     Quick Questions
1.      Please list all the courses or relevant experience that helped prepare you to serve as a caseworker
        assisting homeless persons. Include courses from any department, extra-curricular work,
        research, volunteer activities, internships, work experience, other languages spoken/written, etc.

2.      Name all other organizations/jobs you are currently involved in. Please list and include
        an estimate of hours spent per week on each.

3.      What are your plans for this coming summer? Will you be in town?

4.      How many more years of school do you have?

5.      Can you fluently speak and/or write in any foreign languages?

6.      Do you currently hold any leadership positions?

7.      Choose two songs that best describe you/sum up your life and explain why.

8.      Will you have a car next year? Are you willing to drive it to clinic?

9.      Please rank the following committees in the order of your preference (1-most desired, 6-least):
        *See MCP website (www.mcp.ucla.edu) for detailed descriptions of each committee

        Database         ______           Health Ed                 ______
        Referrals        ______           Outreach                  ______
        Grantwriting     ______           We-Ho Logistics           ______

        *Please provide a short explanation for your primary committee preference
III.   Short Answer
Please briefly respond to the following questions. Your responses should be specific and
concise. Your answers are an extremely important part of the selection process.

1.     How did you hear about the Mobile Clinic Project at UCLA? How will this
       course/program fit into your academic/work/extra-curricular activity load for the
       upcoming academic year?

2.     What is your current relationship or past experience in working with the medically
       indigent, homeless, and generally underserved populations? What interests you most
       about working with the homeless/low income and why do you wish to get involved?

3.     What do you expect to gain from your participation in the Mobile Clinic Project at
       UCLA? What do you think you can contribute to the student-run program and to the
       lives of those clients served?

IV.    Degree Progress Report (DPR) – Please attach your degree progress report (only
courses taken, GPA, number of units completed) – PLEASE DO NOT attach full DPR).

				
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