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Carceral Health Coalition Leadership Application
Thank you for your interest in becoming a CHC student leader. To be considered, please fill out the form below. Please do not hesitate to reach out if you have any questions.
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* Indicates required question
What is your name?
*
Your answer
What is your email?
*
Your answer
What year will you be for the 2024-2025 school year?
*
M1
M2
M3
M4
What activities did you participate in with CHC this past year?
Your answer
What was your most memorable experience from the year and what did you learn from it?
Your answer
Which activities would you be interested in helping lead next year? If you have new ideas for next year, let us know under other! (select all that apply)
Carceral facility tours/ shadowing/ rounds
Organizing didactic sessions for students
Medical parole
Other:
Why do you want to become a student leader for CHC?
Your answer
Do you have any new ideas for the club?
Your answer
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