St. Luke's – Roosevelt Emergency Department

Applying to the Program

Please find the dates for our upcoming term here.

These are the instructions for new applicants. If you have been a part of the program before, you are now a returner -please follow here.

For a complete list of the necessary steps, please download our checklist. We ONLY accept online applications -no paper copies. Therefore please submit all of the following documents as PDF files titled: “LastName_FirstName_FormName.pdf”

1. Acquaint yourself with the program and its commitment.
2. Please fill out the Academic Associate Application. You will also need to attach:
   • A copy of a government ID (driver’s license, passport, etc).
   • Your most recent resume.
3. After reading the Volunteer Handbook, please take the Volunteer Exam.
4. Obtain two (2) letters of recommendation.
   • If you are enrolled in a university, please have your dean or advisor fill out this form. This will count as one letter.
     • If you are not currently enrolled, please have an employer submit a letter of reference to academic.recommendation@gmail.com.
   • The second letter should be a personal character reference. Please have the referrer submit the letter to academic.recommendation@gmail.com
5. Complete the Health Assessment Form.
   • You may go to St. Luke’s Employee Health Services (EHS) to have it completed.
   • You may complete your PPD at a separate location, but we still require EHS validate your results using the form above.
6. Complete your Human Subjects Research Certification. After registering:
   • For Question 1: Select St. Luke’s-Roosevelt Hospital Center as your participating institution.
   • Question 6: No CME/CEU credits.
   • Institutional Email: Use your personal or school email address.
   • Place of Work: Emergency Department.
   • Role in Research: Research Assistant.
   • Course: Basic IRB Committee Course.
   • You will need to save the certificate (example here) as a PDF to include with your application.
7. Please fill out the EmSTAT Confidentiality Form.
8. Please fill out the HIPAA Document.
9. Please fill out the Shift Selection Form.

Have Questions? Take a look at our FAQs.

If you have a question that is not answered here or in our FAQs, please contact the Academic Associate Chiefs.