(785) 864-4073 cco@ku.edu

Health Advocate Application

Name*
First Last
Address*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Email*
Phone*
What is your year in school?*
- First year
- Second year
- Third year
- Fourth year
- Fifth or above
What are you studying?*
Include major(s) and minor(s).
In around 250 words, please describe what empowering local communities through health education means to you. Describe an experience of when you have done this before.*
If you have no prior experience, please provide an example of an experience you would like to have.
In around 250 words, please describe what collaboratively advocating alongside local health departments and agencies means to you. Describe an experience of when you have done this before.*
If you have no prior experience, please provide an example of an experience you would like to have.
In around 250 words, please describe what meaningfully engaging in health promotive services means to you. Describe an experience of when you have done this before.*
If you have no prior experience, please provide an example of an experience you would like to have.
Would you be interested in applying to be a Health Navigator? Please see the attached description below to learn more about our Health Navigators program.*
- Yes
- No

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