Health Care Ambassador Application

A College and Career Readiness Group

Thank you for your interest in the Health Care Ambassadors program with YWCA Minneapolis. This is a program for girls and non-binary youth (grades 9-12) interested in the health care field and passionate about advocating for accessible health care.

Program Highlights

Explore health care areas of study and career paths
Examine inequities and advocacy in health care
Meet and learn from women in the medical community
Opportunities to volunteer, job shadow and intern
Your enrollment covers snacks and bus tokens

Requirements and Commitments:

Currently enrolled in school in the Twin Cities Metro area
Be in grades 9-12 in the 2021-2022 school year
Commit to attending bi-weekly meetings at YWCA Midtown on Thursdays from 4:30 — 6:30 pm, December 2, 2021 — May 19, 2022, with breaks for holidays. Dates are subject to change. Staff will be in touch with applicants in early fall with updates
Be able to provide feedback and participate in program evaluations

Applications are due by Sunday, November 7, 2021. Applicants will be notified by November 19.

Health Care Ambassador Application

Participant Information
Name*
First Last
Address*
Street Address Address Line 2 City State ZIP Code
Email*
Phone*
School*
Grade*
Ethnicity*
Any medical conditions/allergies/dietary restrictions? (If yes, please list)*
Do you qualify for a Free or Reduced Lunch Program?*
- Yes
- No
- Not Sure
Are you able to commit to attending bi-weekly meetings at YWCA Midtown on Thursdays from 4:30 – 6:30 pm, December 2, 2021- May 19, 2022, with breaks for holidays?*
- Yes
- No
If "no," please share any challenges:
Are you applying with a peer from your school? If so, please share their name and grade:
Parent/Guardian Information
Name*
First Last
Address*
Street Address Address Line 2 City State ZIP Code
Email*
Phone*
Relationship to Applicant*
Short Response Questions
Please respond to the questions below with a 2-3 minute video submission or short written responses. If you are submitting a video submission, you must upload it to YouTube/Vimeo and send us the link. If you are submitting short responses, please answer below.
Are you submitting written responses or a video submission?*
- Written
- Video (please share the URL below)
Video Upload URL Link
1) Please tell us about yourself. List activities that you are involved in (sports, community, school, etc.).
2) Why are you interested in being a Health Care Ambassador? Which health care fields are you currently interested in?
3) What do you view as the most critical issue facing youth today? What changes would you like to see to this issue?
4) Should you be selected to be a Health Care Ambassador, what would you hope to accomplish for your community and other youth you would represent?
5) What are your long-term career and academic goals? How would being a Health Care Ambassador support these goals?

Health Care Ambassador Application

A College and Career Readiness Group

Program Highlights

Requirements and Commitments:

Health Care Ambassador Application

Participant Information

Parent/Guardian Information

Short Response Questions