Christ Clinic Summer Institute Application 2021
Summer Medical Institute at Christ Clinic
The Summer Medical Institute is a yearly program in which pre-medical students come for an intensive 4-week experience in the summer. Participants see all aspects of patient care and work through our curriculum that emphasizes integrating faith and the practice of medicine. Students review curriculum materials with a volunteer physician. This program is open to all college students who have completed at least one year of their studies.
Contact Information
Name
First Name
Last Name
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Phone Number
-
Area Code
Phone Number
Email
example@example.com
Back
Next
Sessions
The Summer Institute Program will be divided into 2 sessions. Each student will be asked to commit 25-30 hours per week during the sessions.
Please indicate which session(s) in which you are applying for.
Session: July 1 - August 1, 2021
Questions
Current school and grade level (expected graduation date)
Future plans (MD, NP, PA, nursing or other)
How did you hear about this program?
Can you speak Spanish?
Fluent
Moderate
Minimal
Any other languages?
(Put N/A if this does not apply)
What are your long-term goals? How do you believe this experience will impact that?
Who, in your opinion is Jesus Christ and how do you relate to him?
Back
Next
Special Skills or Qualifications
Summarize special skills and/or qualifications you have acquired from employment, previous volunteer work or through other activities, including hobbies or sports.
Why do you want to participate in Christ Clinic's Summer Institute Program?
Emergency Contact
Please list the contact person(s) to notify in case of an emergency.
Name
First Name
Last Name
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Phone Number
-
Area Code
Phone Number
Email
example@example.com
Back
Next
Resume and/or Letters of Reference
Please include your resume and/or two letters of reference. Letters of reference can be from a professor, employer, pastor or an individual/organization in which you previously volunteered for.
Attachments
Browse Files
Cancel
of
Agreement and Signature
By submitting this application, I affirm that the facts set forth in it are true and complete. I understand that if I am accepted as a volunteer, any false statements, omissions, or other misrepresentations made on this application may result in my immediate dismissal.
Name
First Name
Last Name
Date
-
Month
-
Day
Year
Date
Our Policy
It is the policy of this organization to provide equal opportunities without regard to race, color, religion, national origin, gender, sexual preference, age or disability.
Thank You!
Thank you for completing this application form and for your interest in volunteering with us for our Summer Institute Program!
Submit
Should be Empty: