--> Synergy Medical Education Alliance - MSU-CHM Saginaw Campus - Volunteer Experience Database Entry Form

Volunteer Experience Database Entry Form





Date:
 
Student Name:
Volunteer Organzation:
Address:
Phone number:
Contact person:

Category of Experience:
(Check all that apply -  Hold Ctlr key)
Population Served:
(Check all that apply -  Hold Ctlr key)

Other:

Other:
 
   
   
Time Commitment (hrs/month):
 
Describe role of agency in the community:
Eligibility requirements for clients/patients:
Describe Your Responsibilities/Activities while at the agency:
 
Reflection on Experience:  This is a written narrative.  Examples of questions you might expand upon include but are not limited to the following:

*What did this experience help you to learn/realize/appreciate?
*How did the experience expand your professional/personal interests?
*How did you feel your work impacted the community?
*How will you use this experience during residency and when you are out in practice?