Authority Health Schweitzer Youth Program Application : Authority Health

Welcome to the Schweitzer Youth Program! Below you will find information regarding the process and deadline for application submission, as well as our meeting dates and times. Please read the information carefully to ensure you and your parent understand the commitment required to participate in this program.

Please note:
- Applications are due by Jan. 6, 2023
- Students must be in the 10th, 11th, or 12th grade
- Parents must review the application materials and their signed acknowledgement must be part of the application
- All applicants will be notified by Jan. 13
2023 Schedule:

Feb. 11 to March 25
All classes are on Saturday, 9 a.m. to noon.

Cancellations may occur due to weather conditions, faculty availability and other unforeseen circumstances. Notice will be given in advance.

Thank you for your interest in applying to the Authority Health Schweitzer Youth Program. We look forward to reviewing your application.

Sincerely,
Authority Health
Thank you for your interest in applying to the 2023 Schweitzer Youth Program!

Eligibility requirements:
- Students who attend Schools in Detroit.
- Cumulative GPA will be a consideration.
- Students that have an interest in the health or human services fields.
- Students in the 10th, 11th, and 12th grade in the fall of 2022.
To apply:
- Applications due Jan. 6, 2023.
- You will be asked to upload your transcript, recommendation letter and a picture of yourself to this application.
- If you have any questions, please contact Shelley Golsky at 313-871-3751 or email sgolsky@authorityhealth.org.

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Student Information
Student Name*
Phone Number*
Email Address*
Have you ever been subject to disciplinary action for academic reasons at any of the schools you have attended?*
- Yes
- No
Have you ever had any disciplinary actions taken against you while at school?*
- Yes
- No
Will you be able to attend all five sessions?*
- Yes
- No
How did you find out about the Schweitzer Youth Program?*
What is the best way to contact you?*
- Email
- Phone
- Text

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Parent/Guardian Information
It is my understanding that I, as parent/guardian, will support my participant in the following ways:
- With my participant, I will arrange transportation for my participant to arrive on time to every session.
- I support the decision that any behavioral misconduct or insubordination is grounds for immediate dismissal from the program.
- I understand the Saturday sessions will end promptly at 12 noon and will ensure a timely pick-up of my participant from all Saturday afternoon activities.
- I understand my failure to do so may result in my participant’s inability to further participate.
Class Schedule

All classes will be on Saturday from 9 a.m. to 12 noon at the MSU DMC site: 4707 St. Antoine, Detroit, MI 48201.
- Date: 2/14/21
  Time: 9 a.m. to noon
  Opening Ceremony (2 guests invited) 9 a.m. to 10 a.m.
- Date: 2/19/21
  Time: 9 a.m. to noon
- Date: 2/26/21
  Time: 9 a.m. to noon
- Date: 3/5/21
  Time: 9 a.m. to noon
- Date: 3/12/21
  Time: 9 a.m. to noon
- Date: 3/19/21
  Time: 9 a.m. to noon
- Date: 3/26/21
  Closing Ceremony (2 guests invited) 9 a.m. to 11 a.m.
Parent/Guardian Name*
First Last
Phone*
Email Address*
Preferred method of contact*
- Phone
- Email
Parent/Guardian Signature*

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Activities

On the activities form provided below, please indicate any extra-curricular activities (any activities outside of school), volunteer work, or certifications that you have been involved with. These activities do not need to be medically related. Providing the total cumulative number of hours (per week/month is not accepted).
Activities
Position/Organization Beginning date Is this activity ongoing? Combined total hours Duties/Responsibilities

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Essay Requirement
Why are you interested in participating in the Schweitzer Youth Program with Authority Health?*
What does health equity mean to you and how will it affect your future career goals?*
Plagiarism or falsification of any information automatically disqualifies your application.
Plagiarism consent*
I certify that the information I have supplied for the purpose of this application is true and original. I understand that my materials may be subject to verification and if found to be plagiarized will require me to leave the program.*
Print Name*
Date*

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Letter of Recommendation

Please upload your letter of recommendation below. The letter should be written by a professional who can speak to your personal, professional, and/or academic characteristics (teacher, counselor, pastor). Letters may not be written by a family member.
Upload Letter of Recommendation*
Accepted file types: pdf, Max. file size: 4 MB.

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School Transcript

Please upload your unofficial school transcript
School Transcript*
Accepted file types: pdf, Max. file size: 4 MB.

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Personal Photo

Please provide a professional photo (headshot, school photo) in JPEG format, no larger than 4 mb.
Photo Upload*
Accepted file types: jpg, jpeg, Max. file size: 4 MB.

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Position/Organization	Beginning date	Is this activity ongoing?	Combined total hours	Duties/Responsibilities

Schweitzer Youth Program Application

Please note:

2023 Schedule:

Student Information

Parent/Guardian Information

Class Schedule

Activities

Essay Requirement

Letter of Recommendation

School Transcript

Personal Photo