First Name *

Last Name *

Mobile Phone *

For example, 123-456-7890

Please Select Interests *
 Health Connections (Princeton University Students Only)

What is your class standing? (Note: the Health Connections program is currently unavailable to first semester freshmen) *
Second Semester FreshmanSophomoreJuniorSenior

What is your major/intended area of study? *

What inspired you to apply to be a Patient Advocate for the Health Connections Program? (Max. 200 words) *

What specific skills, qualities, or experiences do you possess that would make you an asset to the Health Connections Program? Do you have any previous experience related to healthcare, social services, or community development? *

What other major time commitments (work, sports, extra-curriculars, etc.) do you have this semester and how do you plan to manage your time to commit to this program? (Max. 150 words) *

Are you able to commit to 50 volunteer hours within a two-semester commitment, as required by the program? *
YesNo

Are you able to attend the mandatory volunteer training on 9/30/23 from 10am-2pm if accepted? *
YesNo