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UCLA Head and Neck Surgery Visiting Student Scholarship Application

The UCLA Department of Head and Neck Surgery seeks to foster a culture in which issues of justice, equity, diversity, and inclusion underscore our missions in delivering patient care, in training the next generation of leaders in Head and Neck Surgery, and in expanding our academic reach through the pursuit of leading-edge research. The UCLA Head and Neck Surgery Visiting Student Scholarship Program provides financial support for two senior-level U.S. medical students on the UCLA Head and Neck Sub-internship Clerkship Rotation 490.01. These students must demonstrate an interest in fostering equity, diversity, and inclusion in healthcare professions, in advancing efforts to reduce healthcare inequities, and in the pursuit of social justice.

Please submit this application AFTER you have completed your VSLO application for HN-HN490.01 Head and Neck Surgery elective.

*This application cannot be saved, please complete only when you are ready to submit. Thank you.

First and Last Name

Email Address

Medical School

Year in Medical School

Do you self-identify as being Underrepresented in Medicine (African American, Latinx, Native American, Native Hawaiian, or mainland Puerto Rican)?

Yes
No
Decline to State

Please describe your previous work, volunteerism, or research experience related to fostering diversity, equity, and inclusion in healthcare professions, in fostering efforts to reduce healthcare inequities, and in the pursuit of social justice (500 words or less).

If the following statements apply, please describe in 300 words or less your experience in the following. Have you or a member of your family been adversely affected by health inequalities related to local or systemic failures of the health care system? Or, have you lived in a community or area that is adversely affected by health inequalities? These include urban or rural areas whose residents have low health status or who are underserved by the health care system.

Please briefly describe.

If your answer to the previous question was Yes, please describe how these experiences have influenced your career choice in medicine and/or how they might affect the way you plan to practice medicine in the future (300 words or less). (i.e. how is this going to change the way you practice).