Select a community of interest. It is important that the community selected be one in which a CLC group member currently resides. Students residing in the chosen community should be assigned to perform the physical assessment of the community.
Perform a direct assessment of a community of interest using the “Functional Health Patterns Community Assessment Guide.”
Interview a community health and public health provider regarding that person’s role and experiences within the community.
Interviews can take place in-person, by phone, or by Skype. Complete the “Provider Interview Acknowledgement Form” and submit with the group presentation.
Develop one set of interview questions to gather information about the role of the provider in the community and the health issues faced by the chosen community. Compile key findings from the interview, including the interview questions used, and submit with the presentation.
Provider Interview Acknowledgement Form
Student Name: __________________
Section & Faculty Name:_________________________________
Date of Interview: ________________
Provider Name :
(i.e. MS, RN, etc.)
I _______________________acknowledge that I was interviewed by _____________________on the
(Provider Name) (Student Name)
date listed above. The organization / agency does not endorse the university or the student however, the student learning experience is considered appropriate for educational purposes.
Provider Signature Date Signed
Acknowledgement form is to be returned to the student for electronic submission to the faculty member.
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