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Global Health Application

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

  • Part I. Applicant Information

  • Part II. Program Director Information

    Applications are accepted only if your Program Director has approved your participation in this global health elective.
  • 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.
  • 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.

  • 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 bottom of this application.
  • Part I. Applicant Information

  • Part II. Program Director Information

    Applications are accepted only if your Program Director has approved your participation in this global health elective.
  • Part III. Global Health Program Information

  • 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.

  • 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 bottom of this application.
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