SUMMA HEALTH SYSTEM - AKRON CITY HOSPITAL



SUMMA AKRON CITY & St. Thomas Hospitals

Application for 4 week Mentoring Elective

INSTRUCTIONS:

1. Return your completed application to the address listed below. Applications must be received two months prior to elective request.

2. Attach a short personal statement (1 page) discussing your activities, ideas and interest in your elective request and need for financial assistance.

3. Request a letter of verification of student status from the Dean at your medical school as well as a letter of recommendation and have both sent to the address listed below.

4. Provide proof of PPD (Tuberculosis)/immunization testing and results.

5. Recent photo

6. Proof of malpractice/liability insurance

PERSONAL:

Name________________________________ E-mail Address_______________________

Address______________________________ Permanent Address___________________

____________________________________ ___________________________________

Telephone____________________________ Telephone___________________________

EDUCATION:

High School Attended__________________________________________________________

Name City State

Pre-Medical College____________________________________________________________

Name City State

Medical College_______________________________________________________________

Name City State

VOLUNTEER EXPERIENCES:

___________________________________

___________________________________

CLUBS/MEMBERSHIPS:

___________________________________

___________________________________

AWARDS:

___________________________________

___________________________________

INTERESTS & HOBBIES:

___________________________________

___________________________________

Elective Date Requests: ___________________ ______________________

Mail completed application to: Summa Health System

Medical Education Department, Suite G4

55 Arch Street

Akron, Ohio 44304

or email the Medical Education Department:

medicaleducation@.

The office of Medical Education is committed to embracing opportunities striving towards educational benefits of a diverse physician workforce, including enhancing the cultural competency of all physicians it educates and improving access to care for underserved populations. The mentoring elective program is an opportunity to offer underrepresented medical students hands-on experience to career opportunities in the medical profession. Thus, fostering a learning environment for students to excel as medical professionals and ultimately meet the health needs of the population served.

Eligibility for elective:

• 4th year medical student in good standing

• Complete mentor elective application 2 months prior to elective request

• Proof of documented immunizations

• Letter from dean’s office fro elective approval from accredited US and Canadian medical schools and letter of recommendation

• Recent photo

• Proof of malpractice/liability insurance

• Attach a short personal statement (1 page) discussing your activities, ideas and interest in your elective request and need for financial assistance if applicable.

Mail completed application to: Summa Health System

Medical Education Department

55 Arch Street, Suite G4

Akron, Ohio 44304

or email the Medical Education

Department:

medicaleducation@

Questions? Call (330) 375-3107 or

1-800-322-0517

................
................

In order to avoid copyright disputes, this page is only a partial summary.

Google Online Preview   Download