Create Your Account

Use the form below to register for your account.

Account Information

Application Questions

Education

Emergency Contact Information

Demographics

A first-generation college student is defined as a student whose parent(s)/legal guardian(s) have not completed a bachelor's degree at a four-year college or university. This means that you are the first in your family to attend a four-year college/university to attain a bachelor's degree. Being first-generation is a very proud accomplishment. We recognize that you will face unique experiences as you begin this exciting journey, and we look forward to supporting you through your experience with the CHSC!

Interests

Primary care includes health promotion, disease prevention, health maintenance, counseling, patient education, diagnosis and treatment of acute and chronic illnesses in a variety of health care settings (e.g., office, inpatient, critical care, long-term care, home care, day care, etc.). Primary care is performed and managed by a personal physician often collaborating with other health professionals, and utilizing consultation or referral as appropriate.Primary care provides patient advocacy in the health care system to accomplish cost-effective care by coordination of health care services. Primary care promotes effective communication with patients and encourages the role of the patient as a partner in health care

Pre Program Survey

Authorization & Consent

I certify that the information provided is accurate, I also understand that participation in the Collegiate Health Service Corps requires attendance at all activities (unless time off has been excused). The Collegiate Health Service Corps and its agents are given permission to reproduce for publications and Internet use any photos taken at program functions. If I choose to withdraw my permission, I must provide written notification.

I Agree

Confidentiality Agreement

As a Collegiate Health Service Corps Participant I agree to follow all rules, policies, and procedures of both my service learning site and the CHSC to the best of my ability. I also agree to respect the confidential nature of all records and any personal contact I may have with the community and other CHSC participants. I understand that I am expected to be professional and maintain confidentiality at all times, whether dealing with client records, projects, or conversations, and abide by the obligations of contractual confidentiality agreements. This includes, but is not limited to conversations, computerized information, and participant/community records and charts. I will report any suspected breaches of confidentiality to my AHEC Collegiate Health Service Corps Coordinator.

I Agree

 

Already have an account?