UAlbany SPH CSA Community Health Project Dominican Republic Summer 2017 Internship Application Form Summer 12-week International Internship working with under the UAlbany SPH-CSA Community Health Project in the Dominican Republic (DR) offers a broad array of experiences related to public health practice in a developing country context. The UAlbany-CSA Community Health Project Intern will work with colleagues from Community Service Alliance (CSA) which has its main office in Santo Domingo, in the DR. They will primarily work to support the ongoing UAlbany-CSA Community Health Project working in the Batey Communities around the city of El Seibo. Major duties may include the following: Assisting in short and long term program/service planning, program implementation and analysis, and program evaluations for activities involving collaboration between CSA and the local communities being reached as part of the UAlbany-CSA Community Health Project Assisting in the establishment of program standards, policies, strategies, goals, and evaluation plans regarding disease/epidemiological surveillance Collecting and interpreting data and information from a variety of sources and preparing recommendations and reports accordingly Preparing and making presentations to staff at the El Cerrito Clinic on data analysis results from patient chart reviews targeting quality improvement initiatives Serving as liaison, committee member, or similar point of contact with internal and external representatives Job assignments will include these specific objectives: 1. Assist in the establishment and sustainability of community health data collection and analysis 2. Assist in evaluating the impact and/or effectiveness of public health program initiatives in meeting CSA s organizational objectives 3. Prepare reports for updating the CSA Program staff on existing community collaboration programs 4. Develop recommendations based on evaluation findings and assist with their implementation 5. Participate in fund-raising and grant-writing for service provision and program initiatives Available Funding / Support It is expected that some funds will be made available to support the travel costs and a portion of the housing costs associated with this internship. Language: Proficiency in Spanish preferred. Application Due : Completed Applications must be submitted by email to John Justino (jjustino@albany.edu) and Carol Whittaker (cwhittaker@albany.edu) by close of business on Tuesday, January 31, 2017. 1
A. Student Information Name of Applicant (Last, first, middle initial): Address: Email Address: Phone Numbers: MPH Concentration: Name and Email of Faculty Advisor: Undergraduate Education Institution and location: Degree Confirmed/ Field of Study Cumulative GPA Previous Experience Abroad Country Inclusive s Purpose (5-10 words) Foreign Languages Spoken: Degree of Competency: Speaking Writing 2
B. Student Interests and Motivations Research/Community Activity in College/Graduate School (use bullet points) Research Community Activity Present Career Interests (200 300 words) Courses taken previous which are/may be relevant to selected research topic 3
Briefly describe why your experience, qualifications and personal characteristics make you particularly suited for your role in this project? (300-400 words) C. Resume / CV Please attach an updated copy of their Resume or CV to your application. D. References Please submit a list of three academic and/or professional references, including their current titles and contact information. E. Faculty Advisor Support Applicants are also required to discuss their interest in the Engeye Health Summer Internship with their Faculty Advisor and to then have their Advisor sign below as an indication of their support. Name and Title of Faculty Advisor (please print) Faculty Advisor Signature 4
F. Release and Indemnification I hereby elect voluntarily and on my own initiative to travel and work as a CSA Summer Intern. I acknowledge that the full responsibility for any personal injury or illness, accident, risk or loss, or property damage that may be sustained by me as a result of being engaged in activities while I am a CSA Intern is mine. In particular, I acknowledge that I am fully aware of the risks and hazards associated with my travel and international internship assignment at CSA, including risks relating to political unrest in connection with my travel to certain countries. I acknowledge that the CSA Internship Committee and the University at Albany School of Public Health shall not be responsible for any illness, injury, accident, damage or loss suffered by me from or in connection with my participation as a CSA Intern, and hereby release and agree to hold harmless the CSA Internship Committee and the University at Albany School of Public Health, and its officers, directors, employees, and agents from any liability, illness, injury, or accident that may be sustained by me while participating as an Engeye Health Intern. I further acknowledge that I have adequate health and accident insurance. This release and hold harmless agreement is binding on myself, heirs, assigns, and personal representatives. Name of Applicant (please print) Applicant Signature G. Certification APPLICANT CERTIFICANTION AND ACCEPTANCE: I hereby certify that the statements herein and the information in the attached documents are true and accurate to the best of my knowledge. Name of Applicant (please print) Applicant Signature 5