EmailMe Form - Camp Med 2023 Proposal

Camp Med 2023 Proposal

To apply to host a Camp Med program, please fill out and submit this form by June 5, 2023. You will be notified of the program acceptance status by June 15, 2023. Funding will be based on your submitted proposed budget and dispersed when programs are confirmed.

If you cannot complete this form at one time, you can save your work and return it later. When complete, PLEASE BE SURE TO HIT "SUBMIT" ON THE LAST PAGE.

Please send any questions to patricia.parrish@conehealth.com.

Thank you for being so interested in Camp Med 2023!

About You
Please provide your contact information, as the person completing this form, in case we need to follow up with any questions about your proposal.
Applicant's Name *
First Last
Applicant's Title and Organization *
Applicant's Email *
Applicant's Phone *
### - ### - ####
About the Coordinator
Please complete the following information about the person who would act as Coordinator of the program.
Coordinator's Name *
First Last
Coordinator's Position/Title *
Coordinator's Organization *
Coordinator's Address *

Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country / Region
Coordinator's Phone *
### - ### - ####
Coordinator's Fax
### - ### - ####
Coordinator's Email *
About Your Area
Please complete the following information about where the program would take place.
County *
School System/District *
What healthcare facilities and other educational partners would be involved? *
Which counties would you recruit students from? (Please check all that apply.) *
Alamance
Caswell
Chatham
Guilford
Montgomery
Orange
Randolph
Rockingham
Please provide an address for secure delivery of camp supplies. *

Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country / Region
About Your Planned Program
Please tell us about your plans for the program.
In general terms, how will each day be structured? *
Who will staff the camp? Please include name and summer contact information including cell number for each staff member. *
Do you plan to incorporate the resources and tools that are available to students from the College Foundation of North Carolina and from Piedmont AHEC's Health Careers program - and if so, how? *
Would you like to schedule any Piedmont AHEC speakers as part of your program? (Note: Subject to availability.) *
What criteria will be used in recruiting and selecting a diverse group of students who mirror the demographic make-up of your county? *
Provide the address and a description of the camp site/location. *
Describe a community service activity that your students will perform. *
Describe how you will continue to maintain contact with your students during the following school year. *
Describe how you will evaluate the outputs/outcomes of your program. *
List the proposed dates of the camp. Camps may be held within one calendar week or can be held on specific weekdays and should total 20 or more hours. *
About Camp Med's Objectives
Briefly explain how your planned program will help students meet the following objectives.
"Objective 1: Describe roles and responsibilities, career outlook, salary ranges, educational preparation and credentialing of select health professions."

How will your program help students meet this objective? *
"Objective 2: Describe state-of-the-art health technology, equipment and procedures used in various health professions."

How will your program help students meet this objective? *
"Objective 3 (Behavioral Health Integration): Develop an understanding of the health care delivery system and the principles of medical ethics and safety."

How will your program help students meet this objective? *
"Objective 4 (Practice Transformation): Experience a learning environment which integrates school life with expectations for the future adult world of work."

How will your program help students meet this objective? *
"Objective 5 (Interprofessional Education): Meet health care practitioners and health professions students who share health career goals."

How will your program help students meet this objective? *
"Objective 6 (Cultural Competency): Explain what medical cultural competency is and why it is a critical component of the healthcare delivery system."

How will your program help students meet this objective? *
“Objective 7 (Social Determinants of Health): Explain social determinants of health within the context of current emerging health issues and why it is a critical component of the healthcare delivery system.”

How will your program help students meet Objective 7? *
Required Attachments
Please upload your supporting documents here.
Please attach a copy of your proposed program outline with your curriculum delivery model. *
Examples of details to include:
- Will you have live or virtual sessions or a combination of both?
- How will you partner with health and educational partners in your area?
- Will you provide at home science or dissection kits with for hands on activities with the students, and if so, where will you obtain them?
Please attach a copy of your proposed budget. *
When preparing your expense report, please note the funding will be disbursed when programs are confirmed by the AHEC Director. We will need a completed W9 for processing.

EMF Contact Form

Report Abuse

About You

About the Coordinator

About Your Area

About Your Planned Program

About Camp Med's Objectives

Required Attachments