Rural Community Health Project
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Pre-Medical Rural Community Health Project This summer program offers premedical students with an interest in rural health and opportunity to participate in a six to eight-week Preceptorship with a primary care provider. Each student works on an intervention program to improve health problems or to prevent illness in a rural community. Application deadline is April 21.
Candidate's Name (Last, First, Middle Initial):
Present City, State, Zip:
Present Phone # (including area code):
Last date you can be reached at Present Address:
Permanent City, State, Zip:
Permanent Phone # (including area code):
Please give us permission to share your email address with the other participants:
Please give us permission to publish pictures taken during the 'Project' that include you:
Social Security Number:
Are you interested in family practice as a career?
Period available for Project (inclusive dates, list any flexibility):
Do you speak Spanish?
List any personal needs (i.e. housing, religious, financial, etc.):
Describe your interest in rural medicine, including why you want to be a physician. List extracurricular activities and include relevant information on your background.
--- Must provide your own transporation ---
A letter of recommendation from your pre-med advisor or professor is required.
Send to: Carolyn Sliger, Rural Programs Coordinator, Department of Family Medicine, ETSU Box 70621, Johnson City, TN, 37614