Columbia County Medical Society

Health Care Challenge 1997-98

Student Handbook

Application

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COLUMBIA COUNTY
HEALTH CARE CHALLENGE

Application 1998-99

Rules and Regulations

Eligibility

  1. Any student, or student resident of Columbia County in grades 1-12.
  2. Sons and daughters of Physicians are not eligible.
  3. Students in grades (1-4) are encouraged to enter as groups or classes.
  4. Students in grades (5-12) are to enter as individuals.

Requirements

  1. No human or animal experimentation project will be eligible.
  2. Applications are to be postmarked by Midnight 30 November 1997.
  3. Applications are to be sent to:
    Clarence B. Henry, MD
    Columbia County Medical Society
    848 Columbia Street
    Hudson, NY 12534
    ATTN: CCHCC
  4. Use black ink only. Print legibly or type application information.

Mailing

  1. The name of the student must appear on each application page in the upper right hand corner.
  2. Be sure to submit any supplemental form i.e. (if a group or class participants, list all the students working on the project).
  3. We encourage early entrees. If you would like your application acknowledged, please include a self-addressed, stamped post-card with your application. Our staff is limited and will be unable to answer any calls to see if your papers have arrived.

Materials

Each student should have a copy of the Columbia County Health Care Challenge Student Handbook and this Information and Application.

COLUMBIA COUNTY HEALTH CARE CHALLENGE
APPLICATION FORM

All applications must be postmarked by November 30, 1997. Early entries are encouraged. Send to Clarence B. Henry, MD, Columbia County Medical Society, 848 Columbia Street, Hudson, NY 12534, Attn.: CCHCC.

PLEASE TYPE OR PRINT

Title of Project:

Medical Topic of Research:

(check one)
___Infectious/Parasites ___Gastrointestinal ___Musculoskeletal/
___Immunology/Allergy ___Gynecology/Obstetrics/Breast Connective Tissue
___Hematology/Oncology ___Ear, Nose, Throat ___Neurologic
___Cardiovascular ___Ophthalmic ___Psychiatnc
___Respiratory ___Nutritional/Metabolic ___Managed Care
___Genitourinary ___ Endocrine ___Geriatrics

Student Information

Please tell your gender and date of birth. If entering as a group or class, submit information on a separate sheet of paper.

Last name, First name Middle name:

Street:

City, State Zip Code:

Telephone Number, Male/Female, Date of Birth:

STUDENT INTEREST: What occupation do you hope to follow after graduation? What would be your second choice?

Choice #1-

Choice #2 -

School Information

School Name, Grade:

School Street Address:

School Town, State Zip Code:

Principal's Last Name, Principal's First name:

School Telephone Number:

Full Name Of Teacher:

FILL OUT ONE PARAGRAPH FOR EACH SECTION:

Description of Project.

Why did you choose this project?

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