IAFP Summer Externship Student Application

Student Summer Externship Experience Application

Externships are open to current first and second year medical students (except for UIC/Pilsen which is open only to current 1st year students). Preference will be given to applicants who hold a leadership position at their school's FMIG. Deadline to apply is May 1. This program is made possible with a matching grant from the AAFP Foundation, and funding support provided to the Family Health Foundation by UIC and Gibson Area Hospital.
Click here for the description and details of the FQHC Experience. Click here for more information about the Full Scope Rural Experience and click here for the UIC/Pilsen Health Equity Experience to help you decide which to apply for. Students may apply for any or all options if you are interested in more than one experience.

NOTE: You should check with your medical school to confirm if your liability insurance will be in effect if you participate in this program. Students are responsible for providing proof of liability coverage from their school or obtaining temporary coverage at their own expense to complete the externship experience.

Hospitals and clinics in the United States and throughout the world require medical students to carry medical professional liability insurance (malpractice insurance). Whether a student is on a clinical elective, a rotation, or just observing, each extersnship will require students to be insured in the event of a lawsuit. Learn more here
Name*

First NameLast Name
AAFP Number*
Preferred E-mail Address*
Preferred Phone Number*

Area CodePhone Number
Medical School*
Expected Graduation Year*
How are you involved with your campus Family Medicine Interest Group?*
Upload a photo or scan of your student ID here

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Please provide proof of medical liability coverage (NOT your own health insurance) that would be in effect during the four weeks. It can be a policy number and contact information or you may upload a document PDF from your school proving proof of coverage for you as their student. If you upload a file please type "attached" in the box below as your answer to this question. *
You can upload proof of Medical Liability insurance here

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Upload your CV here*

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Which externship(s) you are you applying for*

Full Scope Rural ExperienceFQHC ExperienceUIC/Pilsen Food Pantry Health Equity Experience
List any weeks during the summer you are NOT available to participate*
List the weeks you are most available to participate here*
If you have a specific patient population or other specific interest please describe below
For FQHC Applicants: Please use the space below to answer this question: What do you hope to learn about the people served by Mile Square Health Center and the role community health centers in improving the health of a community?
For Rural Full-Scope Applicants: Please use this space to describe your interest in experiencing care provided in a rural community. How will this experience be similar to or different from your personal story?
For the UIC/Pilsen Externship: Please use this space to describe your interest and/or experiences in community service or addressing food insecurity in improving health outcomes.

One a scale of 0 to 10, what is your current interest in Family Medicine*

	0	1	2	3	4	5	6	7	8	9	10

0 is Worst, 10 is Best

Are you willing to commit to this program for the entire four week period, including submitting a weekly online report on your participation, attending a meeting with your preceptor and IAFP staff for the final evaluation, in addition to any requirements set by the externship site and/or preceptor? By clicking YES, you agree to these terms if you are selected for the externship.

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Student Summer Externship Experience Application