2020-Summer-Champs-Application

2020

C.H.A.M.P.S
Community Health Applied in Medical Public Service
A UAMS-Sponsored Summer Program for students entering 8th – 10th Grade

----------------------Program Dates: June 8th-June 12th, 2020
Application Deadline: Friday May 15th, 2020
Dear Educator and parents:
On behalf of the University of Arkansas for Medical Sciences Northwest, we would like to share information
about the upcoming C.H.A.M.P.S. Program with your students who might be interested in eventually
pursuing a HEALTH-RELATED CAREER.
C.H.A.M.P.S. is:
• A summer weekday program held at UAMS NW, Fayetteville
•

•

Tuition-free for all students selected for the program.
For Jr. High school students who have completed 7th, 8th or 9th grade.

C.H.A.M.P.S. Program Activities include:
•
•
•
•
•

•

Friends and Family CPR

A complete review of careers associated with medicine and health-related professions
Instruction on the importance of health promotion and disease prevention in medical care
A variety of hands on activities that demonstrate understanding of basic science theories and health models
Information to build a better understanding of medical terminology
Increased awareness of teenage health-related issues, enabling each individual to make better-informed decisions based
on scientific data.

Qualifications for the C.H.A.M.P.S. Program:
•
•
•
•

School transcript with a 2.5 or greater cumulative G.P.A.
Completed C.H.A.M.P.S Application with student/parent signatures
Commitment to attend every day of the program
Recommendation from teacher and/or school counselor

Please mail original completed applications with transcripts to:
UAMS-NW Attention: Ana Sanchez
1125 N. College Ave.
Fayetteville, AR 72703
Student Notification:
•
•
•

All students will be notified via US Mail regarding their program selection status
Students (or their parents) must provide their own transportation to and from the program each day.
This program takes place at UAMS Northwest 1125 N. College Ave Fayetteville AR 72703

If you have any questions or require additional information please contact:

Ana Sanchez email: phone: 479 684 5177 (direct line)

Page 1 of 10


Page 2 of 10


C.H.A.M.P.S
Community Health Applied in Medical Public Service
A UAMS-Sponsored Summer Program for students entering 8th – 10th Grade

----------------------¿Cuándo se llevará acabo el programa?: del 8 al 12 de junio de 2020
Fecha límite para aplicar: viernes 15 de mayo de 2020
Estimados padres y maestros:
nos gustaría compartir información sobre uno de los programs académicos con estudiantes que
pudiesen estar interesados en una profesión en el campo de salud. Este programa académico se lleva
acabo durante elverano en la Universidad de Ciencias de la Salud de Arkansas, UAMS Northwest. El
program es C.H.A.M.P.S. (Salud Comunitaria Aplicada Al Servicio de la Medicina para el Público)
¿ Qué es C.H.A.M.P.S?
• Es un programa académico llevado acabo en UAMS NW, Fayetteville
•

El programa es gratuito para todos los estudiantes seleccionados a participar.
Es para estudiantes que terminaron 7th, 8th or 9th grado.

•

•

Resucitación caridiopulmonary (CPR Family and Friends)
Un listado informativo sobre muchas de las profesiones en el campo de la salud y sobre la importancia de las ciencias y
las matemáticas.
Actividades que demuestran cómo los profesionales de la salud trabajan en conjunto para major la salud de la
comunidad.
Excursiones a clínicas y hopitales con presentaciocines y ponencias de profecionales.
Proveer a los estudiantes información sobre colegios y universidades locales.

•
•
¿Q actividades se llevan acabo en C.H.A.M.P.S?

•
•
•

¿Cóomo puedo participar en el programa C.H.A.M.P.S?
•
•
•
•

Historial académico con un promedio de 2.5 o mejor.
Llenar la solicitud de participación de C.H.A.M.P.S y firmarla
Comprometerse a participar los días que dura el programa.
Cartas de recomendación de maestros o de una consejera.

Enivar solicitud a:

UAMS-NW Attention: Ana Sanchez
1125 N. College Ave.
Fayetteville, AR 72703
¿Cómo se notificará al estudiante?
•
•
•

Se notificará por corresondencia a todos los estudiantes seleccionados.

La universdidad no proporcionará transporte.
CHAMPS se lleva acabo en UAMS Northwest 1125 N. College Ave Fayetteville AR 72703

Si tiene alguna pregunta o desea más infromación, no dude en comunicarse con:

Ana Sanchez email: phone: 479 684 5177 (direct line)
Page 3 of 10


Page 4 of 10


C.H.A.M.P.S
Community Health Applied in Medical Public Service
Juon Summer Būrookraam̗ UAMS ej bōk eddon ak jipanjōr e ri-jikuul̗ eo
ro rej pād ilo kilaaj: 8th – 10th Grade
----------------------Burookraamm in ej jino ilo: June 8-12, 2020
Jemļom kin ebok abolmom keejen: Bōlaide, May 15th, 2020
Ñan ri-kaki eo / Jinen im Jemen ri-jikuulm eo:
Ilo etan University of Arkansas n̄ an Medical Sciences ilo Northwest, kom koņaan jaar meļeļe kein kon burookraam in

nm aetan C.H.A.M.P.S ippān kajojo ri-jikuulm ro im rej koņaan ak wor itok-limo ilo bok jerbal ko lo jikin takto ko (HEALTH
RELATED CAREER).
C.H.A.M.P.S ej:
• Summer burookraamm in ej bok jikin aolep raan ilo UAMS Northwest, Fayetteville
• Juon burookraamm eo ejjelok oņean n̄ an ri-jikuulm ro renaaj kāālet er.
• N̄an ri-jikuulm ro rej pād ilo Jr. High im emmoj aer kadedelmomk kilaaj 7 th, 8th ak 9th.
Burokraam ko an C.H.A.M.P.S rej:
• First aid im lije support ak bwe ri-jikuulm eo en CPR Certify
• Juon laajrak kon jikin jerbal ko kon takto in un oak mon takto ko
• Meļeļe ko ikijen aorokin ājmour im wāween bobrae na n̄ inmej ko ilo jikin takto ko.
• Elon̄ activity ko kwonaaj bok kuņaam ie im katak kaki bwe kwon meļeļe kon basic science im model ko kon
ājmour.
• Meļeļe ak katak ko n̄ an am kaalom k im mmwilalm lak ilo am kojerbal tom omm ko an jikin takto.
• Kalapļọk ekkol ko kon nan̄ inmej ko rejelot ri-mandred ro, kwomaron̄ kajojo ñan ko mmmmane jet lmom nmak ko
rekar im emmmman im rej pādpād ioon scientific data ko.
Wāween ko bwe kwon pād ilo burookraamm in an C.H.A.M.P.S
• Katak ko am ak school transcript ko am kon 2.5 im lon̄ lo
m mk
• Dedelmomk in am kanm nme abolmomkeejen eo am ippān jain in etam ak etan jinem im jemom
• Kallimmur in pād ilo burookraamm in aolep raan
• Leta in recommendation ko jen ri-kaki ro am ak counselor ro am
Jouj im jiln̄ inlmomk e abolmomkeejen in ippān grade ko am n̄ an:
UAMS Northwest Attention: Ana Sanchez
1125 N. College Ave.
Fayetteville, AR 72703
Wāween kojelmāiki ri-jikuulm eo:
• Aolep ri-jikuulm ro im renaaj kāālet er n̄ an burookraa mm in renaaj kojelmāiki er ilo mail.
• ri-Jikuulm ro (ak mama im baba ro aer) ej aikuj wor ial aer jen im n̄an ije nm burookraa mm in enaaj bok jikin
• Burookraamm in enaaj bok jikin ilo UAMS Northwest 1125 N. College Ave. Fayetteville, AR 72703
N̄e ewor am kajjitok ikijen meļeļe kein ak kokoņaan bok meļeļe ko re lmap lmomk, jouj im kurtok:

Page 5 of 10


Ana Sanchez email:

phone 479-684-5177 (direct line)

C.H.A.M.P.S. Program Application
2020
Community Health Applied in Medical Public Service
University of Arkansas for Medical Sciences (UAMS)

UAMS-NW Fayetteville
June 8th - June 12th, 2020
DEADLINE TO APPLY: Friday, May 15th, 2020

Please print clearly
Name

_______
First

Middle

Last

Male / Female (circle one) Race___________________ Birth date_______/______/_________
Month / Day / Year

Do you go by a different name? If so, what is it? __________________
Home Address
Street or PO Box

City

State

Zip

_______

Email Address_____________________________________(if you don’t have one, create one)
Cell Phone (

)

Home Phone_(

_ )_____

Parent/Guardian Name(s) ____________
Parent/Guardian Contact (Cell phone)_______________Home/Office______________
Emergency Contact (if different from Parent/Guardian)
Emergency Contact (Cell phone)_________________Home/Office_________________

School Name

High School Graduation Year

Page 6 of 10


Grade ______________Cumulative School GPA

Adult T-Shirt Size (100% cotton)

S

M L

XL

XXL

(circle one)

List your significant SCHOOL activities, achievements and awards of the past two years.
(Please write neatly. Attach another sheet of paper if necessary.)

List your significant NON-SCHOOL (community, church, etc.) achievements of the past two years.
Also, describe any jobs or duties at home or school that demonstrate your level of commitment to a task.
(Attach another sheet of paper if necessary)

Please write in your own words why you are interested in attending CHAMPS and why you want to learn
about health careers. Your response to this question is very important in the selection process. If you need
more room, attach another page to your application.

Acceptance Statement
You must agree to attend the full length of the program [June 8 th-June 12th, 2020 (5 days)]. Please note that this

is a day program and that transportation to and from each daily session is your responsibility.
Signed: ___________________________________________________ Date: ________________________
*Student Signature

Permission Statement
Page 7 of 10


I hereby grant permission for my son/daughter to apply to this program and for school officials to report my
child’s achievements and grades. I understand that if my son/daughter is accepted, we will be responsible for
his/her daily transportation to and from the program.
Signed: __________________________________________________ Date: _________________________
* Parent/Guardian Signature

ATTN STUDENT! When your application is complete and signed, mail it to the address below along
with other required paperwork. If you have questions, please call Ana at 479-684-5177

Page 8 of 10


CHAMPS School Recommendation Form
(Information from school personnel will remain confidential)
Student Name: _____________________________________________________________________
First

Middle

Last

Gender: ___________________

School Name: _________________________________________________
School Address: ________________________________________________________________
__________________________________________________________________
Attach a readable transcript of this student’s grades to this form. Include citizenship grades or comments.
Please state why you think this student would benefit from participating in CHAMPS. Comments should be
made regarding the student’s abilities and potential for success in a health care environment. Use the space
provided, then sign at the bottom of this page. (Attach another sheet of paper if necessary.)

*Teacher signature: _______________________________________ Date: ________________

Academic endorsement
I have discussed pertinent information on this form with this student and agree that he/she is genuinely
interested in participating in the CHAMPS program.
*Counselor’s signature: _______________________________ Date: _____________________
*These signatures are required in order for the student to be considered by the selection committee.

ATTN EDUCATOR! PLEASE NOTE ALL COMPLETED APPLICATIONS WITH
th
TRANSCRIPTS (Including Cumulative GPA) ARE DUE BY May 15 , 2020 to:
UAMS-NW
CHAMPS PROGRAM
c/o Ana Sánchez
1125 N. College Ave
Fayetteville, AR 72703

Feel free to contact me with any questions at…
Page 9 of 10


(479) 684 5177

Page 10 of 10