Highland Hospital, dept. of Emergency Medicine - Andrew Levitt Center Visiting Elective Scholarship Program

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Each year, our department rewards a handful of rotator scholarships to EM-bound students coming from traditionally Underrepresented in Medicine backgrounds. We are proud to partner with the Andrew Levitt Center for Social Medicine to make these scholarships available.

In addition to completing the application below in its entirety, please also make sure to complete a formal Visiting Student Learning Opportunities (VSLO) application to Highland Hospital Emergency Medicine Clerkship EM: 140.40 via the online portal, including all requirements as detailed in the application.

FOR YOUR TIME MANAGEMENT: there is a personal statement, and two briefer questions at the end of this document. It might be easier to answer these in a separate document before copying them to this google form.

For any questions about this process, please email Idella Watts, iwatts@alamedeahealthsystem.org

Thank you for taking the time to apply to come rotate with us!

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Edit: 2023 applications are now live!

Full Name (First Last)

Date of Birth *

JJJJ

Address Line 1 *

Address Line 2 *

City *

State *

Zip Code *

Primary Email *

Secondary Email

Phone Number *

Gender

Female

Male

Non-Binary

Prefer not to say

Anders:

Current Medical School *

Do you have a disability? (physical or mental impairment that substantially limits one or more major life activities) *

Yes

Do not wish to provide

If identifying as disabled, which of the following describes your disability/disabilities?

Hearing

Visual

Mobility

Anders:

Please feel free to expand on the previous about history of disabilities

Do you come from a Disadvantaged Background? *

Yes

If Yes, to above, please check category

Family with annual income below established low income thresholds (https://www2.ed.gov/about/offices/list/ope/trio/incomelevels.html)

Social, cultural or educational environment such as that found in certain rural or inner-city environments that have historically made it difficult for individuals to participate in a medical career

Anders:

Are you apart of the first generation in your family to attend college? *

Yes

Race/Ethnicity (OPTIONAL, check all that apply)

African American / African / Black

Caucasian / White

East Asian

Southeast Asian

Hispanic/Latinx

Middle Eastern / North African

Native Hawiian / Pacific Islander

Native American

Anders:

Please feel free to expand on your race and ethnicity above (OPTIONAL)

Sexual Orientation (OPTIONAL - only if you choose to share this information)

How did you learn about our program? *

Medical School

SNMA

LMSA

Friends

Mentor

VSAS

Anders:

Are you related to any employee, officer or board member of Highland Hospital or the Andrew Levitt Center for Social Emergency Medicine? *

Yes

If yes to above, please elaborate

QUESTION 1: In brief, why are you applying for this scholarship? *

QUESTION 2: List your most important leadership /research experiences, and briefly tell us why these are important to you. *

QUESTION 3: Personal Statement, please describe how your background has influenced the type of physician you want to be, and the types of communities that you want to serve. (500 words or less) *

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