OCE: Valley Fellowship Community-based Organization Project Proposal

Since 2002, the Office of Community Engagement (OCE) Valley Fellowship Program, generously supported by the Valley Foundation, sponsors a paid fellowship program for Stanford Medicine medical students. We match/connect medical students with community-based organizations (CBO) in Santa Clara or San Mateo Counties to collaborate on community-responsive research or service projects. OCE invites our community partners to propose project ideas we present to medical students for their consideration. All proposed projects should include the following criteria: 1) Focus on service-learning with clear project and learning goals, objectives, and outcomes 2) Addresses a specific need identified by your CBO, in alignment with principles of community engagement, and must be rooted in the need identified by your organization. 3) CBO is in San Mateo or Santa Clara Counties

Proposal Deadlines:

-SPRING QUARTER '22 (April 1-June 31) | Due March 1, 22 -SUMMER QUARTER '22 (July 1-September 30) | Due June 1, 22 -FALL QUARTER '22 (October 1-December 31) | Due September 1, 22 -WINTER QUARTER '23 (January 1-March 31) | Due December 1, 22

COMMUNITY-BASED ORGANIZATION

Name of Your Community-based Organization*

Website*

Your Full Name and Title (include credentials, if applicable)*

Email Address*

Phone Number*

Department*

Address*

City*

State*

Postal Code*

Project Supervisor

Please designate a member of your organization (if someone other than yourself) who will take responsibility for supervising and mentoring the student and their project. The Project Supervisor shall: 1) Develop a detailed project plan, goals, outcomes, milestones with support from OCE and students 2) Track student's milestones 3) Mentor student 4) Report student's progress (including milestones, successes and challenges)

Supervisor's First, Last Name, Title (and credentials, if applicable)*

Email Address*

Phone Number*

PROJECT PROPOSAL

Proposed Project Title*

Proposed Project Description*

Please provide a brief overview of the project (Max 150 words)

Project Goals and Objectives or Scope of Work*

Please describe specific tasks to be accomplished as part of project.

Project Quarter

Select

Project Deliverables and/or Milestones*

Please list and/or describe anticipated outcomes of project

Number of Days and Hours required to complete your project*

Note: Days and Hours are based on the actual number of Full Time Work Days/Hours for the summer quarter, e.g., July 1-September 30, 2019. Please select one (1) time frame which is best suited to complete your project’s needs and goals:

Select

Proposed Project Start Date*

Proposed Project End Date*

Desired Student Work Schedule: Days per Week*

Based on your entry above, please enter the days of the week you expect the student to work on their project (e.g., Mondays only, M/W, T/Th)

Desired Student Work Schedule: Hours per Week*

Based on your entry above, please enter the number of hours you expect the student to devote to their project per week:

Select or enter value

Desired/Required Student Qualifications*

(e.g., language proficiency, access to a car, weekend availability)

Required Training

Please check box if student is required to participate in trainings or certifications specific to your agency and/or their project. Please list below:

Required Trainings or Certifications:

Background Information/Context*

Describe additional information pertinent to the project

Community Partner Agreement

I. PURPOSE & SCOPE The purpose of this agreement is to clearly identify the roles and responsibilities of each party as they relate to mentoring future medical professionals through the Valley Fellowship Program II. RESPONSIBILITIES UNDER THIS AGREEMENT A. The Office of Community Engagement agrees to: 1) Conduct the training necessary for the medical student to successfully work with the staff, and other members of the community-based organization 2) Provide access to necessary information including schedules and staff contact information to successfully complete project objectives 3) Serve as a liaison between the community-based organization and medical student, and 4) Evaluate the success of the partnership using performance measures that are mutually agreed upon. B. Community Partner agrees to: 1) Focus on service-learning with clear project and learning goals, objectives, and outcomes 2) Address a specific need identified by the CBO (in alignment with principles of community engagement, and must be rooted in a need identified by the CBO. 3) Provide engaging enrichment and mentorship for Stanford medical students: a. Focused on: Scope of Work b. On: days of the week specified in agreement c. From: contractual date range 4) Substitute policy: a. The community partner will provide a qualified, prepared, and trained substitute in event of regular supervisor’s absence and notify medical student if a substitute cannot be arranged. 5) Participate in 1 hour presentation/training in the following topics: a. Valley Fellowship's Program mission b. History and the community we serve 6) Track student progress, attendance, deliverables, and milestones 7) Communicate with the OCE staff about the progress, successes and challenges 8) Participate in efforts to measure the success of the project 9) Provide at least 3 weeks advance notice if partnership needs to be discontinued for any reason 10) Accompany and support your student during their Community Health Symposium poster presentation.

Community Partner Affirmation*

I have read the above statement and

Select or enter value

Today's Date*

Additional Comments

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