SHL at AHPL Fall 2024 Application

Student Healthcare Leaders (SHL) at Adventist Health Portland (AHPL) Fall 2024 Application

Submission deadline is Tuesday, September 17, 2024.

Basic Eligibility Requirements

Applicants must:

*be a high school student

*submit a complete application (including application, video or written essay, and recommendation)

Please review the dates and times below. If you already know you'll miss more than one (1) class, please wait and apply to a future session when you can attend all classes.

Week	Date	Time
Week 1	Tuesday, October 1	5:00pm - 7:30pm
Week 2	Tuesday, October 8	5:00pm - 7:30pm
Week 3	Tuesday, October 15	5:00pm - 7:30pm
Week 4	Tuesday, October 22	5:00pm - 7:30pm
Week 5	Tuesday, October 29	5:00pm - 7:30pm
Week 6	Tuesday, November 5	5:00pm - 7:30pm
Week 7	Tuesday, November 12	5:00pm - 7:30pm
Week 8	Tuesday, November 19	5:00pm - 7:30pm
Week 9	Tuesday, November 26	5:00pm - 7:30pm
Week 10	Tuesday, December 3	5:00pm - 7:30pm

Name*

First NameLast Name
Preferred Name (if applicable)
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
E-mail*

Confirmation Email
Cell Number*
Home Number
Does your family qualify for free or reduced price lunch?*

YesNo
High School*
GPA*
Grade*
Date of Birth*

MonthDayYear
Date
Jacket Size*
Ethnicity*
Gender*
Preferred Pronouns
Which SHL session have you previously applied for?*

I haven't applied beforeSpring 2024Fall 2023Spring 2023Fall 2022Spring 2022Fall 2021
Parent/Guardian Name*

First NameLast Name
Parent/Guardian Number*
Parent/Guardian Email*

Confirmation Emailexample@example.com
Emergency Contact Name (if your parent/guardian named above is your emergency contact, please re-enter their name here)*

First NameLast Name
Emergency Contact Number (if your parent/guardian named above is your emergency contact, please re-enter their contact number here)*
Emergency Contact Relationship*
Do you have an immediate family member who works in the healthcare field?*
Will you be a first-generation college-bound student (neither parent has graduated from a two or four-year college)?*
How did you learn about this program?
What is your career interest (select all you are interested in)?*

PhysicianNursePharmacyTechnicianAdministrationRehab (PT/OT/Speech)Support Services (IT, Clinical Engineering, Marketing, Human Performance, Nutrition, Telecom, etc)UnsureOther
Please list your school and/or extracurricular activities (high school years only)
Please list your community service activities (high school years only)
Please click on the recommendation form below and send the link to a teacher or counselor to complete and submit prior to the application deadline. You will receive an email once your counselor or teacher has completed this.*
Please list NAMES and PHONE NUMBERS for two personal references of people who would recommend you for this program.
Adult Outside of School Reference*

First NameLast Name
Adult Reference Best Contact Number*
Friend/Peer*

First NameLast Name
Friend/Peer Best Contact Number*
Are you fully vaccinated against COVID-19? (According to the Centers for Disease Control and Prevention (CDC), you are fully vaccinated if you have completed a COVID-19 vaccine primary series)*

Yes (if selected for the program, you will need to provide proof of vaccination)No (if selected for the program, you will need to sign a declination form)
Essay This is a REQUIRED activity and you MUST record a video (preferred) or submit a written essay. Please answer the following question.

Why do you want to participate in this program?

Be specific! Video should be 1-2 minutes in length. Please speak clearly and at a natural pace and introduce yourself by stating your name, school and grade at the beginning.

If you choose to write an essay, please include your name, school and grade at the top. Essay should be no more than one (1) page in length.

Please upload your video or written essay here (preferred). If you have issues uploading or would rather email, please send to ahpl@studenthealthcareleaders.org.
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Student Healthcare Leaders (SHL) at Adventist Health Portland (AHPL) Fall 2024 Application