National Consumer Scholars Application 2023-2024

Name*

First NameLast Name

Preferred pronouns

Phone Number*

Email*

example@example.com

Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Best way to contact you*

CallTextEmailOther

Race/ethnicity *

Gender*

Date of birth*

Date

Have you ever been a Consumer Scholar before?*

YesNo

Have you ever attended the Putting Care at the Center conference before?*

YesNo

Please tell us about your lived experience as someone with complex health and social needs, or a caregiver of someone with complex health and social needs. Please provide as much detail as possible since your lived experience is one of the most important factors in our selection process.*

Please tell us about the work you have done or are currently doing as a consumer advocate and/or consumer advisor. Please include any specific information about organizations you have worked with and any projects, advocacy campaigns, committees and/or advisory boards you have been involved with.*

Why are you interested in being a Consumer Scholar, and what do you hope to gain from the program?*

If selected as a Consumer Scholar, do you have any concerns about your ability to fulfil these program requirements:

Be able to participate in the full program year from July 2023 until November 2024 (barring any unforeseen circumstances that might prevent someone from continuing their participation).
Be able and willing to attend and participate in the 2023 Putting Care at the Center conference to be held in Boston, MA from November 1-3, 2023, as well as the 2024 Putting Care at the Center conference planned to be held in Pittsburgh, PA in Fall 2024 (dates TBD). Travel and lodging expenses will be covered, and travel accommodations can be made based on individual needs.
Attend and participate in regular program meetings and training sessions which will be held virtually on Zoom. These meetings will primarily take place Monday-Friday between 12pm-5pm EST/9am-2pm PST. We prefer people to join via Zoom, but can accommodate those who need to call in on a phone.
Actively participate in project work, which is estimated at about 40 hours total between December 2023-September 2024.
Respond in a timely manner to communication and requests from Camden Coalition staff, and proactively reach out whenever you need assistance or information in order to remain engaged in the program.
Be a positive contributor and respectful and engaged member of the 2023-2024 National Consumer Scholars cohort

Do you have any concerns about your ability to fulfil the program requirements that are listed above?*

No, I don't have any concerns about my ability to fulfill these program requirements.Yes, I have concerns about my ability to fulfill these program requirements.

If you answered "yes" to the previous question, please explain what your concerns are.

Please upload a letter of support from a healthcare, social service, and/or advocacy organization that you have partnered or worked with. This does not need to be a formal or paid role and can include participation in a Consumer/Patient and Family Advisory Board, a Working Group, or as a consumer advocate/advisor.

The letter of support should include: 

Organization’s name, mission and vision;
The name and contact information for a staff person who can act as a point of contact for us;
A brief description of the consumer leadership or advocacy work that you have been involved with; 
Why they believe you are a good candidate for the Consumer Scholars program;

If you are unable to upload the letter here, you can email it to ekane@camdenhealth.org. Please note that applications will be considered incomplete without a letter of support.

Upload letter of support