Future Physicians of Oklahoma

Future Physicians of Oklahoma

Deadline: March 1, 2024 - Openings Approximately 10-15 openings per year - Dates June 3- July 28, 2024 - Stipend $1,000-$2,000 depending on location of clinic - Contact Kari Ames Webber, EVP - Email webber@okafp.org
Student Information
Name

First NameLast Name
Email
example@example.com
Address

Street Address

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CityState / Province

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Today's Date

MonthDayYear
Date
SSN
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DOB

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Date
Relative or Friend that can reach you if you move

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Relative or Friend's phone number
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Statistical Information

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Gender
Marital Status
Ethnicity
Educational Information
Undergraduate School attended   Type a label
Graduated   Date
Degree   Type a label
Undergraduate School attended   Type a label
Graduated   Date
Degree   Type a label
OAFP Information
Are you an OAFP member?
Have you attended FCMIG Lunch Lecture?
If yes, how many?
Clinical Experience
Have you ever worked in a clinic or hospital in a clinical capacity?
If yes, where?
What was your position?
How long?
Program Information

This externship will require your attendance at the OAFP Scientific Assembly Friday, August 25th and 26th. You will then spend four weeks with your preceptor, Monday June 5-Friday June 30. There are no extensions. Application deadline is April 15, 2024. Students will be matched by May, and are required to attend the FPO orientation. Students will receive reimbursement for participation anywhere from $1,000-$2,000 depending upon the site of participation. Reimbursement will be issued upon completion of the externship and receipt of all required forms, i.e. reimbursement form, site time sheet, evaluation and Community Involvement Report.
Are you interested in a Rural Site?
Area of the state you would like to be assigned: (list by preference, i.e. 1st, 2nd, 3rd, 4th)
Northwest
Northeast
Southwest
Central
Please list your top three (3) choices if you have a certain city in mind:
'Every effort will be made to place you at or near your preference, however, there is no guarantee you will receive your requested site.' Possible sites include, but are not limited to:
Blackwell, Buffalo, Duncan, El Reno, Elk City, Enid, Frederick, Hobart, McCloud, Muskogee, Midwest City, Norman, Okarche, Oklahoma City, Okeene, Purcell, Ramona, Sallisaw, Shawnee, Stigler, Stillwater, Tahlequah, Tulsa, Weatherford, etc.
1. Type a label 2. Type a label 3. Type a label
Is there a physician who is willing to sponsor you and be your preceptor?
If yes, what is the name? First Name   Last Name
Location?   Type a label
("Sponsorship" involves making a donation to the Foundation to help aid in the payment of the student stipend.)
Experience, Skills, Goals
Describe any prior experience with rural or community health
Describe your personal goal(s) for participating in this program.
Any additional information in considering your application, and any special circumstances that could prevent you from completing your externship?
I, Type a label (STUDENT), agree to participate in the 2024 FPO Program and understand reimbursement will be paid to me upon completion of the externship and that required reimbursement form, site time sheet, evaluation, and Community Involvement Report must be submitted prior to issuance of the reimbursement.
Student Name

First NameLast Name
Student Signature

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Future Physicians of Oklahoma

Student Information

Statistical Information

Educational Information

OAFP Information

Clinical Experience

Program Information

Experience, Skills, Goals