HELPrS Registration

Your Information


PROGRAM DETAILS

 

This year's HELPrS Program is funded by the ICCB Trade Schools Program Grant. HELPrS is a FREE opportunity designed to recruit high school juniors and seniors from underserved communities who may be interested in a career in health professions. The program takes place over two weeks with the goals of helping participants develop professional skills, increase their understanding of the LLCC college environment, and job shadow real healthcare professionals in clinical settings. Lunches, healthcare scrub uniforms, name tags, and transportation to and from job shadowing sites are provided. 


Program Dates
June 9 - June 19 

Days & Times Each Week
Monday-Thursday, 12:00 – 5:00 pm

Location
Lincoln Land Community College Main Campus

Montgomery Hall
5250 Shepherd Road
Springfield, IL

Drop off and Pick up Details 
Montgomery Hall (South side of campus next to the Workforce Careers Center)

Drop off by 12:00 pm

Pick up at 5:00 pm 

 

A Typical Day On Campus (may vary depending on available experiences) 
12:00 pm Lunch at LLCC
12:30 pm Professional Skills Lecture (topics related to college success and professionalism)
1:00 pm Introduction to LLCC Health Programs (workshops and hands-on experiences) 
3:00 pm College Life Presentations
4:00 pm College Support Programs

5:00 pm Dismissal 

A Typical Day Job Shadowing (sites may vary depending on availability) 
12:00 pm Lunch at LLCC
12:30 pm Bus Leaves for Job Shadow Sites
1:00 - 4:30 pm Job Shadowing (at local clinical sites)
5:00 pm Bus Arrives Back at LLCC


Who Can Register?  
High school juniors and seniors, ages 16-20 years old. Priority is given to applicants from the following high schools: Springfield Southeast, Lanphier, New Berlin, Riverton, and Taylorville.

 

Number of Participants 
Program registration is on a first-come first-served basis and is subject to final confirmation. We will accept a maximum of 16 students into the HELPrS program. 

Deadline to Register
Registrations are due by 5:00 pm on April 25. Completed forms are considered on a first-come first-served basis and are subject to final confirmation. Please ensure the contact information for you and your parent/guardian is accurate so we may confirm your registration. 

Your Information
Please provide your information. Do not include your parent's information in this box.







If not, that's ok. The ID will just help us connect you in our system.

Parent or Guardian's Information
Because you will be under the age of 18 at the time of this program, your parent or guardian must complete a waiver form. We will email this form to them. Please provide a valid email address for your parent or guardian. You will not be able to participate in the program until this form is completed.

Emergency Contact 1




Emergency Contact 2




Upload Documents

Upload a copy or legible photo of these required documents to be able to job shadow. The patient’s name must be visible on all health records.

  • Copy of a government-issued ID
  • Proof of COVID-19 vaccination (or a request for a medical or religious waiver of this requirement)
  • Proof of immunizations or titer results for MMR (2 doses) and Varicella (2 doses)
  • TB skin test with negative results






Why? We'll share this with other HELPrS so you can start getting to know each other
Orientation Preference



Waivers and Agreements

Please read each section before checking a box and submitting this form. Submitting the form means you agree to everything stated below.
Acknowledgements and Important Information
Please read the following statements and check the box that you agree to them:
Program Code of Conduct

This program offers you the chance to develop skills relevant to success in college and employment. You are expected to behave in a manner that reflects an understanding and commitment to professionalism. To that end, read this Code of Conduct and indicate your agreement to abide by its terms and conditions by signing below.  

 

Expectation I: Develop your awareness of a variety of healthcare professions. I understand that I will be participating in activities that will help me learn about a variety of healthcare professions and college program options. I will strive to participate fully and improve my understanding.  

 

Expectation II: Adhere to the program’s dress code. I understand that a uniform will be provided to me free of charge along with a name tag. Uniform items are to be worn during the HELPrS program off-campus activities (e.g., job shadowing and off-campus program experiences). I agree to keep my uniform clean and to present a professional appearance during my time in the program. For on-campus activities, I agree to dress in my uniform or in a manner that reflects my professional goals; thus, no bedtime clothing, ripped, or revealing clothing should be worn.    

 

Expectation III: Demonstrate exemplary attendance. I understand I am expected to participate fully in the HELPrS program events and activities and that my attendance is important to my overall performance. I agree to arrive at the program on time each day, following the time and attendance policy.  

 

Expectation IV: Avoid behaviors leading to termination from the program. I understand that my behavior determines my ability to remain in the HELPrS program. I understand the following behaviors are grounds for termination from the program and will result in a loss of all program benefits.  

·         Any threat or act of violence toward another person. 

·         Any aggressive behavior, including but not limited to, sexual harassment. 

·         Bringing a weapon of any kind to any program activity. 

·         Violating safety policies on campus or in off-campus settings, including at job shadowing sites.  

·         Use of profanity or foul language. 

·         Excessive tardiness or absenteeism. 

·         Failure to exhibit self-respect or respect for others. 

·         Any use of, purchase, or possession of drugs and/or alcoholic beverages. 

·         Any stealing or possession of stolen property during any program activity. 

·         Any behaviors that may be considered prejudicial against others based on race, socioeconomic differences, disabilities, religion, sexual orientation, or gender identity.  

Program Accident Waiver and Release Form
I hereby give my permission for myself to participate in the Lincoln Land Community College (LLCC) Healthcare Entry-Level Professional Skills (HELPrS) Program.  
 
Transportation: I understand that program activities can take place at multiple locations including the LLCC main campus grounds, the LLCC Medical District, and various healthcare centers in Springfield, Illinois. I also understand that participants may travel by bus to and from these locations on multiple days during the program.  
 
Medical Consent: I understand that LLCC will make every effort to contact the people designated on the LLCC HELPrS Emergency Contact Form in case of an emergency. I give my permission to LLCC to administer any medications needed and to provide and arrange for and consent to any necessary medical treatment for myself or my child while at LLCC, including onsite and offsite emergency care. I accept responsibility for the costs associated with all such medical treatment.  
 
Medical Conditions: I hereby affirm that I, or my child have/has no medical, mental, emotional, cognitive, or physical conditions that would make it unsafe for him/her/them to participate in the program. 
 
Participant Conduct: I understand that continued participation in the HELPrS Program is dependent on participant conduct which is governed by federal, state, and local statutes, as well as Board policy and rule. The LLCC HELPrS Program Coordinator may, in their sole discretion, dismiss any camp participant for inappropriate, disrespectful, or dangerous behavior at any time.  
 
Use of Property: I understand that participants will take part in laboratory and/or clinical experiences that may involve the use of computers, equipment, and/or other property. If I, or my child, breaks or damages any property because of their direct or indirect behavior, I hereby agree to pay for its repair or replacement.    
 
Assumption of Risks: I understand that participation in the LLCC HELPrS Program includes the potential for accidents and injuries up to and including death. I assume all risks associated with traveling to and from program activities, participating during any program activities, engaging with program participants, and using LLCC property. 
 
Photography Release: I understand that while participating in this program, I or my child may be photographed. I agree to allow their photo, video, or film likeness to be used for any legitimate purpose by the activity holders, producers, sponsors, organizers, and assigns. LLCC may use my or my child’s likeness, voice, and biographical material in connection with publication, promotion, exhibition, and distribution of such material. I understand that no royalty, fee, or any other compensation of any kind shall become payable to me by reason of such release and use of any photograph or video.  
 
In consideration of my application and permitting my child to participate in this program, I hereby:  
 
WAIVE, RELEASE, AND DISCHARGE from any and all liability, including but not limited to, liability arising from the negligence or fault of the Lincoln Land Community College (LLCC), its trustees, officers, employees, volunteers, entities, or other persons released, for my, or my child’s death, disability, personal injury, property damage, property theft, or actions of any kind which may hereafter occur to them including their traveling to and from this activity; 
 
INDEMNIFY, HOLD HARMLESS, AND PROMISE NOT TO SUE Lincoln Land Community College (LLCC), its trustees, officers, employees, volunteers, or other entities or persons released from any and all liabilities or claims made as a result of participation in this activity, whether caused by the negligence of release or otherwise. 
 
The LLCC HELPrS Program Accident Waiver and Release of Liability Form shall be construed broadly to provide a release and waiver to the maximum extent permissible under applicable law. Lincoln Land Community College, its Trustees, directors, officers, and all its employees, acting officially or otherwise are hereby released from any and all claims, demands, actions, or causes of action on account of any injury to my child that may occur arising from or in connection with participation in the Lincoln Land Community College Healthcare Entry-Level Professional Skills (HELPrS) Program from June 10, 2024 through June 20, 2024. This release binds my heirs, executors, administrators, and/or assigns.  

Contact Information