Application for Family Medicine Clinical Rotation

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Application for Family Medicine Clinical Rotation - Medical Students Only

4 week medical student clinical rotation

Email *

Full Name (Last, First) *

Current year in medical school *

Year of expectation from medical school *

Address *

Phone number *

Are you a citizen of the United States, or a permanent resident? *

Have you ever rotated at Unity Health Care before? If yes, when and which clinic locations? *

Medical School *

Program at Institution *

Rotation Start and End dates (4 week rotations; please list 1st, 2nd, and 3rd choices) *

Please list languages you speak other than English *

Institution Contact name, number and email *

Why are you interested in rotating at Unity Health Care? *

Describe one special interest or area (area of medicine, special population, skill set, etc.) that you hope to explore or develop while rotating with us: (diverse patient population, want to educate patients and their families about the healthcare needs) *

What specifically interests you about our residency program? *

Please email your CV to: unityfamilyrotation@gmail.com *

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