Sub-Internship Application

*All fields are required

Name:
E-mail:
Phone:
-
Secondary Phone:
-
Address:
Medical School:
Current year in school:

Preferred Sub-internship date:

First Choice:
Second Choice:
Tell us about your interest in family medicine:
List the learning objectives for your sub-internship in your own words (Do not list your school's objectives):
Do you have family or other ties to the Yakima area?
Do you need a place to stay?
Are you applying for residency here?
Are you a U.S. Citizen or Permanent Resident?

Once you have submitted this form you should receive an email confirmation that it has been submitted successfully.

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