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INTERNATIONAL HEALTH IN THE DEVELOPING WORLD:
CLINICAL AND COMMUNITY CARE

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 How to Apply Links to IH Sites

Please Mail or Submit This Form No Later Than May 1

I. Applicant Information
Date
Name
Address
City, State, Zip
Medical School
 
Month/Year you will complete
Year 3 Medical School
Telephone
FAX
E-mail
   
II. Please write a statement explaining your interest in third world health:
(If you are mailing this application, attach a separate sheet of paper.) 
This statement is considered in the selection process.
 
III. Prior Third World Experience: (This will not affect your selection)
Nation Date and Time Spent Purpose (tourist/work/study/other)
 
IV. Do you have a future elective scheduled in a third world nation?
     (This could possibly affect your selection.) 
Yes or No 
If Yes: 1) How firmly set? 
2) What nation(s)? 
3) When? 
   
V. Any special background interest or needs we should know of?
     (These details will not affect your selection.)
 
VI. How did you find out about this course?

After SUBMITTING APPLICATION,
click your browser's Back button to
return to the International Health Web site.
 

OR RETURN APPLICATION TO:

Ronald E. Pust, MD
International Health Course Director
Department of Family and Community Medicine
The University of Arizona College of Medicine
PO Box 245052
Tucson AZ 85724 USA

 
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Last modified: 1/18/2008