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
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