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Learning Experience: Student Profile
The next step in your career in healthcare starts here.
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School / University
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First name
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Last name
Multi-line address
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Country/Region
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Address
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City
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Zip / Postal code
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Phone
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Email
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Program of Study
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Degree Level
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What year are you in the program?
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What program(s) are you interested in?
Internship
Public Health Practicum
Clinical Rotations
USA Medical Tours
Value Based Physician Training
Residency Placement Program
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How long do you like your learning experience to last?
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What date do you anticipate your learning experience to start?
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What date do you anticipate your learning experience to end?
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What is your anticipated date of graduation?
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Will a memorandum of understanding (MOU) or an affiliation contract need to be signed in order for a student to participant in an internship or clinical rotation?
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What type of learning experience would you like to create for your internship or clinical rotations?
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What are your plans after graduation?
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What is your country of citizenship?
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Do you currently have a passport from your country of citizenship?
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Have you ever had your passport, visa, or travel privileges revoked?
International Students: Have you already submitted paperwork for a United States student visa?
Use this space to list any questions you have for us.
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Upload your program curriculum or training requirements.
Upload File
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Upload your resume or CV.
Upload File
Submit
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