Medical Explorations

Medical Explorations Application 2025
July 21-31, 2025
The Future Docs program is designed for future professionals pursuing a career in healthcare. This program is sponsored by the Chattanooga-Hamilton County Medical Society and the Medical Foundation of Chattanooga to offer college students or recent high school graduates the opportunity to observe physicians and gain an insight in the practice of medicine.
APPLICATION DEADLINE - MAY 28, 2025
Student Demographic Information
Name
Address
City
State
Zip
Phone
Email Address
example@example.com
Gender
Student School Information
Name of Current School/University
City and State of Current School
Current Ranking (1st-4th year)
Expected Graduation Year
Current or Most Recent GPA
Emergency Contact Information
Emergency Contact Name
Relationship to Student
Emergency Contact Phone Number
References / Recommendations

Please complete the information below for two (2) personal references.
Reference 1 Name
Number
Email Address
example@example.com
Job Title
Reference 2 Name
Number
Email Address
example@example.com
Job Title
Health / Dietary Requirements
If you are selected for this program and we need to be aware of certain health concerns, please list:
If you are selected for this program and we need to be aware of special dietary requirements, please list:
Please list your extracurricular activities, leadership positions, awards, personal achievements or recognition within the last three (3) years.
What are your expectations for participating in the Medical Explorations Program?
What competencies and qualities should a physician possess for practice in the 21st century?
Proof of GPA

Cancelof
Letters of Recommendation

Please have two (2) letters of recommendation from a teacher, university counselor, or supervisor sent directly to kevin@chattmd.org
STATEMENT
Please check the boxes to indicate your agreement with each statement listed below.
Signature

Clear
EQUAL OPPORTUNITY STATEMENT: It is the policy of the Medical Society, Erlanger, and the University of Tennessee to provide quality opportunities without regard to race, color, religion, national origin, gender, sexual preference, age, or disability.
- Applicants MUST be at least 18 years of age by July 21, 2025, to be eligible for consideration, NO EXCEPTIONS.
- Only complete applications will be considered.
- Selected applicants will need proof of immunizations and proof of a negative TB skin test within the last 12 months.
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Medical Explorations Application 2025

July 21-31, 2025

APPLICATION DEADLINE - MAY 28, 2025

Student Demographic Information

Student School Information

Emergency Contact Information

References / Recommendations

Health / Dietary Requirements

Letters of Recommendation

STATEMENT