Community & Global Health - Global Health Application

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Please read Program Requirements before completing and submitting the following Affiliated or Non-Affiliated Program Application.

KP Global Health Program Resident Liability Release Waiver

IMPORTANT: All rotations have been suspended through December 31, 2020.

Affiliated Program Application

  • Part I. Applicant Information

  • MM slash DD slash YYYY
  • MM slash DD slash YYYY

  • Part II. Program Director Information

    Applications are accepted only if your Program Director has approved your participation in this global health elective.
  • Max. file size: 50 MB.

  • Part III. Global Health Program Information

    For programs requiring a supervising attending, the GHP Program can assist if needed. This application is a request only for funding and/or participation approval by the Regional GME office . It is YOUR responsibility to contact the institution to inquire about their availability to host you.
  • MM slash DD slash YYYY
  • MM slash DD slash YYYY

  • Part IV. Supervising Staff Information

    Please attach the CV of your Supervising Attending at the end of this application.

  • If you have identified a Supervising Attending to accompany you, please complete the information below.

  • Max. file size: 50 MB.
    You must provide a CV for the Supervising Attending that will accompany you on the trip.

  • Part V. Prior Experience

    If applicable, please list up to three prior global health experiences (include country, year, duration, organization, and nature of work at the location).

  • Part VI. Comments and Attachments

    Please attach the following: 1) Goals & Objectives (required); 2) Expected schedule of your time including days, hours worked, duties you will perform while on rotation (required) 3) Resident Liability Release Waiver (required). Form can be downloaded at the top of this application.
  • Max. file size: 50 MB.
  • Max. file size: 50 MB.
  • Max. file size: 50 MB.

Non-Affiliated Program Application

  • Part I. Applicant Information

  • MM slash DD slash YYYY
  • MM slash DD slash YYYY

  • Part II. Program Director Information

    Applications are accepted only if your Program Director has approved your participation in this global health elective.
  • Max. file size: 50 MB.

  • Part III. Global Health Program Information

  • MM slash DD slash YYYY
  • MM slash DD slash YYYY

  • Part IV. Supervising Staff Information

    Please attach the CV of your Supervising Attending at the end of this application.

  • If you have identified a Supervising Attending to accompany you, please complete the information below.

  • Max. file size: 50 MB.
    You must provide a CV for the Supervising Attending that will accompany you on the trip.

  • Part V. Prior Experience

    If applicable, please list up to three prior global health experiences (include country, year, duration, organization, and nature of work at the location).

  • Part VI. Comments and Attachments

    Please attach the following: 1) Goals & Objectives (required); 2) Expected schedule of your time including days, hours worked, duties you will perform while on rotation (required) 3) Liability Release Waiver (required). Form can be downloaded at the top of this application.
  • Max. file size: 50 MB.
  • Max. file size: 50 MB.
  • Max. file size: 50 MB.
Global Health

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