National Consumer Scholars Application 2023-2024

National Consumer Scholars Application 2025-2026

Before completing this application, please be sure to read our "Request for Applications" (RFA) which includes important information about the Consumer Scholars program and who can apply. The RFA is available at: www.bit.ly/3DQrLIt.
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
Are you eligible for both Medicare AND Medicaid ("dually eligible") and/or the family caregiver of someone who is dually eligible*

Yes, I am eligible for both Medicare and MedicaidYes, I am a family caregiver of someone who is eligible for both Medicare and MedicaidNoI'm not sure
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Unfortunately, if you are not eligible for both Medicare AND Medicaid ("dually eligible") and/or the family caregiver of someone who is dually eligible, we will not be able to select you to participate in the Consumer Scholars program this year. Please keep us in mind for the future when the program may not be specific to people who are dually eligible.
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This year we are only able to select people who eligible for both Medicare AND Medicaid ("dually eligible") and/or the family caregiver of someone who is dually eligible. Before proceeding with the application, please refer to the Request for Applications which includes information about how to know if you are dually eligible. You may also reach out to Evelyne Kane at ekane@camdenhealth.org for assistance.
Race/ethnicity *
Gender*
Do you identify as a member of the LGBTQA+ community?*

YesNoPrefer not to say
Date of birth*

MonthDayYear
Date
Have you ever been a Consumer Scholar before?*

YesNo
Please tell us about yourself! What type of lived experience do you have related to complex health and social needs? What has your experience been like accessing healthcare through Medicare and Medicaid?*
Please tell us about the work you have done or are currently doing using your lived experience to be an advocate and/or advisor. This could include (but is not limited to): being a member of a Community Advisory Board/Patient & Family Advisory Board, work as a Community Health Worker/Peer Specialist, community organizing/advocacy, and/or sharing your personal story as a speaker/presenter. *
Why are you interested in being a Consumer Scholar, and what do you hope to gain from the program?*
Those selected as Consumer Scholars will need to commit to the following program requirements:
- Be able to participate in the full program year from August 2025 until November 2026 (understanding that unforeseen circumstances can always arise).
- Be able and willing to attend and participate in two national conferences including 2025 Putting Care at the Center conference to be held in Portland, OR from October 15-17.
  - 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 are usually scheduled Monday-Friday between 12pm-5pm EST/9am-2pm PST.
- Actively participate in project work, which is estimated at about 40 hours total between December 2025-September 2026.
- Respond in a timely manner to communication and requests from program staff.
- Be interested in using your lived experience to advocate for better healthcare in the U.S.
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 update 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 be 1 page long and include: 
- The name of the staff person writing the letter and the name of the organization they work for;
- A brief description of the consumer/community leadership or advocacy work that you have done with them; 
- 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.

If we do not receive a letter of support by the application deadline (5/31/25) we will not be able to accept your application.
Upload letter of support

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National Consumer Scholars Application 2025-2026

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