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Apply to be an Advo Coach
Advocacy Coach Application
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Name
*
First
Last
Email
*
Preferred email (will not be shared with students)
Enter Email
Confirm Email
Current position/role to be listed by your name:
*
Please select any healthcare issues that you are passionate about:
*
Select All
Food justice
Racial justice
Climate justice
Housing justice
Reproductive justice
Political justice (incl campaign finance reform, voting rights)
Criminal justice (incl police brutality, prisoner rights, drug policy)
Education justice (incl student loan elimination, curriculum reform)
Economic justice (incl wages, occupational health, UBI, sustainable investing)
LGBT care
Disability rights
Chronic disease
Underserved care
Migrant worker rights
Gun violence prevention
Immigrant and refugee rights
HIV, HCV, infectious disease
Single-payer, Medicare for All
COVID-19 pandemic response
Drug prices
Health policy
Global health
Digital health
Geriatric health
Women's health
Child & adolescent health
Mental health (incl addiction, suicide)
Please describe any prior mentoring experience you've had (what has worked well/not so well?):
*
Upload your CV
*
Please provide us with a copy of your CV for our reference.
Drop files here or
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Max. file size: 50 MB.
Upload your headshot
Please provide a high-resolution/high-quality image that we can use for your coach profile on amsa.org/coaches.
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Max. file size: 50 MB.
Coaching policies
Participation as a coach is reliant upon acceptance of the following policies.
Confidentiality
*
As an AMSA Mentor or Advocacy Coach, I agree to a policy of confidentiality. I will maintain in confidence all communications between me and the students who I am mentoring/coaching, including after the mentoring/coaching relationship ends. Exceptions are express permission from a student to share particular information; if disclosure may be necessary to protect the student or another person from harm; and as required by law. I may discuss matters in generalities with designated AMSA staff. I will direct any questions regarding my confidentiality obligations to AMSA staff.
I agree to the policy of confidentiality.
Conflicts of Interest
*
I agree to disclose to the student(s) I am mentoring/ coaching any financial interests/relationships or funding sources pertinent to the issues discussed during our session(s). This includes but is not limited to relationships with manufacturer(s) of any commercial product(s) or pharmaceuticals, non-FDA approved uses of pharmaceutical products or medical devices, or funding sources for novel research. All disclosures must be presented at the beginning of the coaching relationship and, if related topics arise, in subsequent coaching sessions . Please note: AMSA does not view the existence of these interests or uses as decreasing the value to participants but feels these disclosures are important for the participants to form their own judgement.
I agree to the conflict of interest policy.
Non-Solicitation/Non-Recruitment
*
I will not solicit or recruit students who I am mentoring or coaching to participate in other non-AMSA projects/programs.
I agree to the policy of Non-Solicitation/Non-Recruitment.
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