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AHS Medical Student
Externship Application

Application must be submitted no later than March 16, 2012 to be considered. Decision date is April 6, 2012.

Contact Information

 

Address Information
School/Temporary Address
Home/Permanent Address

Externship Location & Dates

Letter for Application (Fields expand to accomodate full response)

Other Information

Note: If checked, proof of valid license and insurance is required

Learning Electives/Preferences

Please indicate all elective learning experiences that you would be interested in observing / participating in and rank your top five (1 = first preference). While your experience will be designed with these preferences in mind, actual experience will depend on staffing and scheduling availability.
                                                                                Interest/Activity
    Rank

Submission of this application will notify AHS of your desire to participate in the Medical Externship and will automatically request a letter of reference from the office of the Associate Dean for Student Affairs, LLU School of Medicine. Applicants from other Medical Schools must contact the AHS Director of Leadership Development for further instructions.

NOTE: If you do not see a confirmation page after clicking Submit, scroll up to check incorrect data that has been flagged.

 
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