AMSA

HEART Application

Humanistic Elective in alternative
medicine, Activism and Reflective Transformation (HEART)
Elective Rotation for Fourth Year Medical Students
March 29-April 23, 2010

Applications will be accepted on a rolling basis in three admission rounds (those who apply by September 1, November 15, and January 31) and reviewed as they are submitted. Upon reviewing your application we will inform you as to whether you have been accepted or deferred. Qualified applicants will be evaluated on a rolling basis....so submit early!!!!!

We will select applicants based on their insight/passion and knowledge/experience in the four areas of complementary and alternative medicine, activism, mindfulness and self reflection, and community.

Name:
Preferred name if different from above:
Gender:
Address:
City and State:
Zip Code:
E-mail Address:
Phone Number:
Pager or Cell Phone Number:
What will be the best way to contact you from now until next April?
In case of emergency contact (name & phone):
School:
Expected date of graduation:
How did you hear about this elective rotation?
Personal Info/Preferences
Do you like your living space: social quiet
Should it look: neat comfortably cluttered
Are you a(n): early bird night owl
Is there a good possibility that you'll be driving to HEART? Yes No
If yes, would you be willing to help with transportation during the elective? (An answer of no will not affect the application.) Yes No
Are you willing or interested in camping for part of your stay at HEART? Yes No
If yes, would you be able to bring a tent or its equivalent? Yes No

In selecting applicants to form the HEART community, the HEART planning team will strive to create diversity with regards to ethnicity, race, income, age, life experience, and cross-cultural experience. How do you see yourself as contributing to this unique community?

Briefly describe any experience in activism regarding medicine, medical education, domestic or international policy, social change or other areas. Describe what you learned from the experience.

Have you studied or do you practice any form of other healing modality (e.g., meditation, tai chi, yoga, qi gong, etc., homeopathy, herbs, body work (including energy healing)?

Yes No

If so, please indicate which modalities, and BRIEFLY explain the place they hold in your lifestyle (1-2 sentences).

We would like to provide each participant with the opportunity to share their unique gifts with the group during our optional evening activities. Please describe a 30 min to 1 hour workshop that you would consider sharing with all of us. Topics include, but are not limited to, healing modalities (meditation, yoga, herbs, etc), hobbies (e.g. knitting, juggling), activism (e.g., specific causes, methods of protest), creative expression (music, writing workshop, art). If you would rather share your information in a form other than a workshop (i.e., not public speaking), please describe."

We encourage student participants to seek support from their school and other resources in their community. Former students who have tried in the past have been surprisingly successful in getting much of their cost for the rotation covered. If you are accepted to attend HEART, we will forward you a letter for your student affairs office or dean to ask for financial help for HEART.

You must also include with your application:

Essays and a CV as outlined below. Please submit in the form of a single Microsoft Word document with your full name as its title, eg, Joe Smith.doc. Please send to:

HEART Student Selection Committee
heartstudents@gmail.com
  • 3 short essays, each no longer than 300 words in length, answering:


    • What are the dreams you have for your life as a practicing physician/healer? (What do you see as your current and future role in medicine?)

    • Why do you feel drawn to participate in HEART? (How might a month of personal reflection serve you at this time? What do you expect to address within yourself during a month of personal reflection?)

    • Briefly describe any experiences you have had living in or being part of a community and what you learned from them. (What thoughts or ideas do you have about the role of community in healing?)

  • CV, with emphasis on extracurricular activities.