Perinatal Health Equity Champions Program Application

Perinatal Health Equity Champions Program
Online Application

Please complete the application below, which includes a personal statement, resume, and letter of reference.

If you do not receive a confirmation email, if you are experiencing technical issues when you try to submit your application materials or would prefer to apply via email, please contact Jennifer Condel at jcondel@jhf.org

About You

First Name*

Last Name*

Preferred Pronouns*

Preferred Email Address*

Permanent Email Address*

Phone Number*

Street Address*

City*

State*

Zip Code*

Education

Certificate/ Accreditation Programs*

Relevant Lived Experience (500 chars left)*

Other Completed Accomplishments (500 chars left)*

What is your current profession?*

Organization/Entity Name*

Program Information

What interests you about the Perinatal Health Equity Champions Program? (500 chars left)*

Have you previously participated in a JHF Fellowship, Champions Program or Summer Internship?* Yes No

Uploads

Personal Statement (Maximum size 5 MB)*

Resume/CV (Maximum size 5 MB)*

Letter of Reference (Maximum size 5 MB): Note: Past Jewish Healthcare Foundation Fellows and Interns do not need to submit a letter of reference

HIPAA and Photo Release Statement

Download HIPAA and Photo Consent form here.

Upload Signed HIPAA and Photo Release Statement

Declaration On Applying

In submitting this application, you affirm that to the best of your belief and knowledge, the information you have given is true and accurate; and that if you are accepted as a Perinatal Health Equity Champion and decide to enroll in the 12-month program, you will complete the program in its entirety. You further commit to respect confidences shared on assignments and throughout the Perinatal Health Equity Champions Program.

If you are experiencing technical issues when you try to submit your application materials, please contact Jennifer Condel at jcondel@jhf.org.

Would you like to be notified of other JHF programming, including the Feinstein Fellowships?* Yes No

Perinatal Health Equity Champions ProgramOnline Application

Application Received!

Perinatal Health Equity Champions Program
Online Application