RHCHP Global Health Pathway Application

Applicant Information:

Date: ______________________

First Name/ Given Name: ________________Last Name/ Surname: ______________________

Preferred Name: ________________Pronouns: ______________________

Regis Email Address: ____________________Other Email Address: ______________________

Current Cell Phone number: _________________________________

May we text you for specific information? Yes or No (Circle one)

Mailing address: __________________________________________

Street: _________________________________________________

City: _________________________State: _____________________Zip: _________________

Education:

What is your primary academic program at Regis University? (ex: Doctor of Physical Therapy, PharmD,
MA in Counseling, MS Nursing Leadership, etc.)

____________________________________________________________________________

Do you have an undergraduate degree(s)? Yes or No (Circle one)

If yes, please list degree(s)_____________________________________

Do you have any other graduate degrees (e.g. MPH, PhD, MS)? Yes or No (Circle one)

If yes, please list graduate degree(s) __________________________________

List previous service-related experiences (i.g., mission trips, service learning, Immersion trips, practicum
and internships with a specific service component, etc.).
_____________________________________________________________________
_____________________________________________________________________
_____________________________________________________________________
_____________________________________________________________________

Curriculum Vitae: Please attach an updated Curriculum Vitae (or detailed resume) to this application.

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 RHCHP Global Health Pathway- Continued
Language Proficiency:

List the language(s) you speak, and corresponding level(s) of proficiency:

Language: Proficiency:

Language Proficiency Levels:

Basic Proficiency (able to satisfy routine survival needs and minimum courtesy requirements)
Limited working proficiency (can handle confidently, but not easily, most social situations and casual
conversations, but would need help handling complications or difficulties)
Professional working proficiency (able to participate effectively in formal and informal conversations on
practical, social, and professional topics)
Advanced/Full Professional Proficiency (able to use the language fluently and accurately for all
professional needs. Can understand and participate in conversations with fluency and precision of
vocabulary)
Fluent/Native Speaker

Questions:

Please respond to each of the following questions. We will use these questions to get to know you as a
person and to learn about the ideas and interests that motivate you. We want to hear your genuine
voice throughout; this is the time to think carefully about the values, passions, and experiences that
shape you as an individual and why you would be a good fit in the Global Health Pathway at Rueckert
Hartman College for Health Professions (attach on a separate page).

1. Why do you want to participate in the RHCHP Global Health Pathway?

2. What are your long-term career goals and how will your participation in the Global Health
Pathway contribute to your future success?
3. Global Health immersions are both a service and learning experience. How will you benefit
personally and professionally from such an experience? How comfortable are you performing
different role(s) and learning from others in these environments?
4. Provide an example of when you worked outside your comfort zone in a culture with different
perspectives than your own. What are some of the benefits and challenges of working alongside
other cultures?

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 5. Tell us about a time when you were part of a group that faced an obstacle and you came up with
a creative solution. What was creative about this solution? Please focus on your role and its
impact on you and the group.

Application Disclaimer:

Students will be notified of the formal acceptance or denial of his/her application into the RHCHP Global
Health Pathway. Accepted students are to notify globalhealth@regis.edu, within two weeks of
notification whether they want to continue with matriculating into the program of if they would like to
withdraw their application and not be considered. Once candidates are selected for admission and
confirmation of matriculation into the program has been made, it is expected that students adhere to
program requirements, procedures, etc. If at any point a student needs to withdraw from the global
health program he or she must submit to the program a signed withdrawal statement indicating the
reason for withdraw.

Students can be dismissed from the program as follows if he/she has demonstrated poor academic
progress. Students failing course work will be evaluated on an individual basis at the respective
academic program level. Students who are struggling to meet primary academic program requirements
may be advised to withdraw from the global health pathway or may be dismissed from the program
upon recommendation from advisors, academic unit leads, and/or dean of the program.

Please send completed application to the following email:

Globalhealth@regis.edu