Medical Student Sub-Internship Application

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Application Instructions

Because most students securing rotations are considering application and because the rotational openings are in high demand, we ask that you answer the following questions by submitting (1) this online application, (2) current Curriculum Vitae, (3) Personal Statement, and (4) an official copy of your Step 1 exam results (USMLE or COMLEX) to Karissa.Gilchrist@ascension.org .

First name Middle initial Last name Street address City State Zip code Email address Cell phone May we text message you? Yes No Medical school Graduation year

First choice

Start date End date

Second choice

Start Date Last Date

Third choice

Start date End date

How did you hear about our program? Please describe where you have been (or are now) doing your clinical rotations. Current clinical rotations Rural setting Urban setting Suburban practice In a University setting In association with a residency program What are you looking for and what do you hope to accomplish by participating in our sub-internship program? Is there anything else that you would like to tell us about yourself? (optional) Are you planning to go into family medicine? Yes No USMLE I/COMLEX I - Passed Yes No Not yet taken or scores pending USMLE II/COMLEX II - Passed Yes No Not yet taken or scores pending

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