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Summer Externship Application

Attention: We are no longer accepting applications until March 2009

Please respond briefly to all of the following questions.

Contact Information
Questions
(community involvement, nursing home visits, etc.)
(distance to site, earlier or later availibility, travel plans, etc.)
(This is just to help get an idea of where you're interested in going.)
Stipulations

Note: The following stipulations only become effective when you have agreed to participate with a physician of your choice.

Stipulations (please read):
If I am selected to participate in the lottery and subsequently matched to a family physician of my choice, I understand that I am committed to completing the eight-week Externship program. I also understand that I will receive one-half of the stipend on June 30th and the remainder on July 31st, contingent upon the Academy office receiving my evaluation three days prior to that date. After July 31st, the Academy will send the remaining stipend after receiving the evaluation form.

Please note:
In order to be eligible for the program, participants are required to submit an evaluation and essay at the conclusion of the summer extern experience before receiving the final stipend. Four essays are selected to receive $500 each.

Membership with the American Academy of Family Physicians/Wisconsin Academy of Family Physicians is also required. Wisconsin AFP pays for student membership dues. (Go to http://www.aafp.org/join.xml to submit a member application.)