Teacher/Facilitator Guide

Last edited: 2/18/15

Thank you for supporting your students and encouraging them to explore opportunities for their future

success. The Gateway to the Health Professions program is a wonderful opportunity designed as an

introduction to the health careers and geared towards exposing minority and disadvantaged high school

students to the wide and diverse world of healthcare. A large number of our past participants have

gone on to be first-generation college students.

The Gateway Program is designed to mimic the college experience, from the application process to the

fast-paced, all-day program filled with activities and workshops.

This year’s program will take place from July 12-31, 2015.

In this packet you will find resources and tips to help you better promote the program to your

students.

Attached items include:

1. Application

2. Promotional Flyer

3. The Gateway program’s essay Grading Rubric

Below are the application requirements for the Gateway to the Health Professions Program:

1. Completed application

2. $35 non-refundable application fee

3. Completed essay minimum 200-words

4. Recommendation Form completed by teacher, principal, guidance counselor or pastor.

If a student wishes to be considered for the week of shadowing in the LLU Medical center (third and final

week of the program), they must be turning at least 17 ½ years by July 2015 and will also need to submit

the following items:

5. Proof of Negative TB skin test (must be dated no older than July 2014)

6. Copy of vaccination records

7. Completed Shadowing Experience form

This items can be submitted with the paper application or submitted through our online application at:

http://lluh.samaritan.com/custom/1432/

Teacher/Facilitator Guide

Last edited: 2/18/15

Tips for encouraging your students:

Host an application party. Organize a time and date for students to complete their applications together so they can ask questions if necessary.

Make a teacher or other leader available to attend the application party (or at another time) to complete the recommendation forms for the students

Provide ideas for essays and demonstrate what the 200 word minimum actually looks like (Roughly one long paragraph or half a page).

Share with students what we’re looking for in an essay and how we will grade. (see attached Essay Grading Rubric for ideas)

A few more things to know:

Deadline for applications is May 22. 2015. All applications AND supporting documents must be received by this time.

This program is limited to students living in Riverside and San Bernardino Counties.

Students do not have to be legal residents of the U.S to apply.

There is no minimum GPA requirement for this program.

A total of 60 students are accepted into the program each summer.

The $35 application fee is non-refundable. It is considered a processing fee (just like college application fees) and a sign of faith that the student will attend the program. Similar summer programs in California can cost $2,000.

Students can only attend the program once.

Preference is given to juniors and seniors.

Only students 17 ½ years old and older (by July 2015) will be considered for the week three shadowing portion of the program, due to hospital policy.

This is a commuter program: Students arrive in the morning and leave in the late afternoon. A small number of host-families are available for students living further than 20-miles away from Loma Linda. Many students utilize the OmniTrans bus system. We also encourage students living in the same neighborhoods to carpool (we can provide that information upon acceptance into the program).

Gateway to the Health Professions July 12-30, 2015 The Gateway Program is designed to introduce underrepresented minorities and underprivileged high school students to the health careers. During the two-week program, students will take part in interactive activities within each of the schools at Loma Linda University and attend workshops. Select students (age 17 ½+) will be chosen to shadow health professionals during the third week. For a full description of the Gateway Program, visit www.llu.edu/caps and click on Community Resources, then Gateway to the Health Professions. Gateway 2015 Schedule Orientation: July 12 Week One: July 13-17 Week Two: July 20-24 Week Three: July 27-30 (week three shadowing is by invitation only) The following items are required for complete submission:

Completed application form Personal Essay: How will participating in the Gateway Program help you make a difference

in your community and impact your future educational goals? (200 word minimum) Personal Recommendation Form completed by a teacher or pastor (see attached) $35 non-refundable application fee (made payable to LLU CAPS or a PayPal payment

submitted to caps@llu.edu) The following items are required to be considered for the shadowing program:

Copy of complete immunization records Copy of negative TB Skin Test, dated after June 2014 Shadowing waiver form (see attached)

Send OR scan and e-mail application materials to: CAPS Office, Attention: Tina Pruna 24945 Mound Street Councilors Student Pavilion, Room 1402

Loma Linda, CA 92350 tpruna@llu.edu

Deadline for submission of complete application:

Friday, May 22, 2015

Gateway to the Health Professions Application 2015

Last Name: ____________________________________________ First Name: _____________________________________ Mailing Address: __________________________________________________________________________________________ City: ____________________________________________ State: _____________ Zip Code: _________________________ Primary Phone: ___________________________ E-mail: _______________________________ T-Shirt Size: ______ Gender: _______ Date of Birth (mm/dd/yy): _____/_____/_____ Current Grade: ⧠ 10th ⧠ 11th ⧠ 12th Race/Ethnicity: _________________________ Religious Affiliation: _______________________ GPA: __________ Name of High School: _________________________________ School Phone Number: _______________________ Parent 1 Name: _____________________________________________ E-mail: ___________________________________ Home Address: ____________________________________________________________________________________________ City: ____________________________________________ State: _____________ Zip Code: _________________________ Primary Phone: _____________________________________ Occupation: ______________________________________ Place of Birth: ______________________________________ Race/Ethnicity: ___________________________________ Finished High School: ⧠ Yes ⧠ No Years in College: ________ Name of College: ____________________ Parent 2 Name: _____________________________________________ E-mail: ___________________________________ Home Address: ____________________________________________________________________________________________ City: ____________________________________________ State: _____________ Zip Code: _________________________ Primary Phone: _____________________________________ Occupation: ______________________________________ Place of Birth: ______________________________________ Race/Ethnicity: ___________________________________ Finished High School: ⧠ Yes ⧠ No Years in College: ________ Name of College: ____________________ Other Contact Name: __________________________________________ E-mail: _________________________________ Primary Phone: ____________________________________ Relationship: _____________________________________

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Gateway to the Health Professions Application 2015

Do you currently have health insurance coverage? ⧠ Yes ⧠ No Do you have any medical issues (asthma, allergies, illness, injuries, etc.)? ⧠ Yes ⧠ No List up to four honor awards and the date received (use a separate sheet if necessary). ______________________________________________________________________________________________________________ ______________________________________________________________________________________________________________ List up to four elected leadership positions and dates served (use a separate sheet if necessary). ______________________________________________________________________________________________________________ ______________________________________________________________________________________________________________ List up to four extracurricular activities and the dates active (use a separate sheet if necessary). ______________________________________________________________________________________________________________ ______________________________________________________________________________________________________________ How did you hear about the Gateway Program? (Check all that apply.) ⧠ Flyer ⧠ Guidance Counselor ⧠ Teacher ⧠ Pastor ⧠ Loma Linda University Website ⧠ Past Gateway Student (or Si Se Puede/College Exodus) ⧠ Other: ________________________________ How will you submit the $35 non-refundable application fee? ⧠ Cash ⧠ Check payable to LLU CAPS ⧠ PayPal submitted to caps@llu.edu

*Applications are not complete until all supporting documents are received.*

For Office Use Only Amount Paid: Date Received: Received by: Data input:

Cash/Check/PayPal/Money Order

Documents Received: □ Essay □ Personal Recommendation Form □ Application Fee

□ Immunization Records □ Current TB Test □ Shadowing Waiver

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Gateway to the Health Professions Personal Recommendation Form

To be completed by the Recommender:

_________________________________________________________ ___________________ Name of Recommender (Please Print) Date

NOTE TO RECOMMENDER: You have been requested to complete this reference form. Your frank appraisal will assist in evaluating the applicant’s qualifications. Please seal your recommendation in an envelope, sign across the seal and either return the envelope to the applicant for enclosure with the application form OR return the recommendation to: Gateway Program, Attn: Tina Pruna, 24945 Mound Street, Councilors Student Pavilion, Room 1402, Loma Linda, CA 92350 OR fax this form to 909.558.7145 OR scan and e-mail this form to tpruna@llu.edu. On a scale from 1 to 5, please rate the applicant’s qualification in the following areas: N/A Below Avg Average Good Very Good Excellent

1. Desire to learn 0 1 2 3 4 5 2. Adaptability/flexibility 0 1 2 3 4 5 3. Resilience 0 1 2 3 4 5 4. Commitment to service 0 1 2 3 4 5 5. Responsibility 0 1 2 3 4 5 6. Sensitivity to people from a different 0 1 2 3 4 5

cultural/ethnic background 7. Level of maturity 0 1 2 3 4 5 8. Potential to succeed 0 1 2 3 4 5 What other information do you feel would be significant to the Gateway Admissions Committee?

In consideration of the total perspective, please rate the applicant for the Gateway Program.

⧠ Highly recommend ⧠ Recommend ⧠ Some reservations ⧠ Serious reservations Signature: _______________________________________________________________ Position/Title: ___________________________________ Address: ______________________________________________________________ Phone: __________________________________________

To be completed by the Applicant:

_____________________________________________ _____________________________________________ Applicant’s Last Name Applicant’s First Name

To the applicant: Under the Federal law entitled the Family Education Rights and Privacy Act of 1974, students are given the right to inspect their records, including letters of recommendation. While we shall consider all letters of recommendation carefully, we believe that in many instances letters written in confidence are overall of greater utility in the assessment of a participant's qualification, ability and promise.

A signature is required for either A or B below, indicating waiver of right to inspect this letter of reference. A. I have waived my right to inspect this letter of recommendation and hereby inform referent that this letter will be kept

strictly confidential. _______________________________________________________ Applicant's Signature Date

B. Referent is advised that I have retained my right to inspect this letter of recommendation and that upon enrollment I may have access to it.

_______________________________________________________ Applicant's Signature Date

Applicant's Signature Date

LOMA LINDA UNIVERSITY GATEWAY TO THE HEALTH PROFESSIONS PROGRAM

SHADOWING EXPERIENCE

INSTRUCTIONS Step I – Please read, complete, and sign Section A.

Step II – Please submit copies of documentation listed in Section B together with your Gateway Application Form no later than FRIDAY, May 22, 2015. Paperwork received after this date will not be accepted.

Mail: Tina Pruna—CAPS Office, 24945 Mound St, Councilors Student Pavilion RM 1402, Loma Linda, CA 92350 Fax: (909) 558-7145 (cover sheet required) Email: tpruna@llu.edu

SECTION A – Please PRINT

CONFIDENTIALITY AND LIABILITY STATEMENTS My signature below indicates that I agree to adhere to a strict code of confidentiality, both verbally and in written material. All information obtained from clients/patients, their records, or computerized data is to be held in confidence. No copies of client/patient records shall be made, and no records or computer printouts, or copies thereof are to be removed from the Medical Center or its facilities unless pre-approved authorization is obtained by designated personnel. If pre-authorization is obtained, all patient information must be de-identified. Clients/patients will not be identified in any manner in paper, reports, or case studies undertaken by me unless specifically authorized by IRB/Research Study. In addition, my signature below indicates that I will, or have already read through the Orientation Guide and will take responsibility for, and will be held accountable for, all the information contained in it. I also agree that NO electronic devices and NO video/photo-taking will be permitted anywhere in our facilities. Failure to abide by this Statement will result in the immediate termination of my experience. Also, as an observer I hereby waive, release and forever discharge Loma Linda University Health (LLUH) and its affiliated entities, associates, partners, agents, employees and volunteers of and from any and all matters, claims and suits of every kind whatsoever which the above signed may have or which may hereafter accrue as a result of or in any way connected with participation in any observation at LLUH or its affiliated entities. I further agree to assume any and all risks and to release and hold harmless LLUH and its affiliated entities, associates, partners, agents, employees and volunteers who, through negligence, carelessness, or otherwise might be liable to the above signed for any personal injuries, loss, cost, wages and any and all other damage resulting from or connected to the above signed for participation in any observation. Lastly, I agree under penalty of perjury, and under the laws in the State of California, that the information I am providing on this Form is true. If I am granted the opportunity to observe, I agree with the Statements above, and I have read through the “Observation Orientation Guide,” and will take responsibility for the information contained in the Guide. I understand and agree that LLUH reserves the right to terminate an observation experience at any time, for any reason.

Observer Name: Email Address:

Street/Mailing Address:

City/State/Zip: __ Phone:

Observer/Parent Signature (must be at least 18 y/o): Date:

SECTION B – Please CAREFULLY READ each item description below.

TB/PPD skin test ■ Documentation of negative skin test results within the last 12 months. ■ If your test results are positive, you are required to submit a completed Health Screening Questionnaire (HSQ) before the start of your experience, and include it with your paperwork. To request an HSQ, please contact Gwen at her email noted above. Tetanus, diphtheria, and pertussis (Tdap) ■ You must have received your tetanus/diphtheria booster shot within the last 10 years. ■ You must have received a one-time dose of Tdap (tetanus, diphtheria, pertussis) Measles, Mumps, Rubella (MMR) ■ Documentation of MMR vaccination date(s) OR Positive blood titer results for each of these diseases Varicella (chickenpox) ■ Documentation of varicella vaccination date(s) OR Positive blood titer result

FOR STAFF DEVELOPMENT USE ONLY Clearance Signature, Manager of Academic Relations Date 01/15 LLUGatewayProgram.doc

For more information, contact Tina Pruna 909-651-5011 | tpruna@llu.edu

to the Health Professions Gateway

INLAND EMPIRE MINORITY & UNDERREPRESENTED STUDENTS EXPLORE CAREERS IN HEALTH

Application Requirements Grades 10-12 Resident of San Bernardino

or Riverside County Completed Application Recommendation Letter Essay $35 non-refundable

application fee Deadline: May 22, 2015

High school students participate in interactive learning

with a healthcare focus, career workshops and more!

July 12-30, 2015*

Apply online at: www.llu.edu/caps

*Select shadowing opportunities offered during July 27-30.

Space limited.

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Essay Rubric:

Essay Question: How will participating in the Gateway program help you make a difference in your community and impact your future educational goals?

Total Points Possible: 15

Criteria

Points

Minimum 200 words

Focus and Detail Purpose of applying

Sentence Structure/Grammar/

Spelling

1

No- Less than 200-word minimum

Did not answer the essay prompt, does not have a focused topic.

Not clear why student wishes to participate

Sentences sound awkward, are distractingly repetitive, or are difficult to understand. There are numerous errors in grammar, mechanics, and/or spelling that interfere with understanding.

2 Very close to the 200-word minimum

There is a topic . Main idea is somewhat clear

Purpose of applying is somewhat clear.

Most sentences are well constructed, but they have a similar structure and/or length. Several errors in grammar, mechanics, and/or spelling that interfere with understanding.

3 Yes- Meets the 200-word minimum criteria without using unnecessary filler words to add length

There is one clear, well focused topic. Main idea is clear but not well supported by detailed information.

Purpose for applying is clear, and there is evidence of interest in the health careers or learning more about the field

Most sentences are well-constructed and have varied structure and length. Few errors in grammar, mechanics, and/or spelling, but they do not interfere with understanding.

4

N/A (No extra points will be provided for essays with a longer word count)

There is a clear, well focused topic. Main ideas are clear and well supported by detailed and accurate information

Student has a clear interest and motivation for pursuing the health careers

All sentences are well constructed and have varied structure and length. The author makes no errors in grammar, mechanics, and/or spelling.