Application

Thank you for your interest in a 4th year Family Medicine rotation at Abington Family Medicine. Please fill out the entire survey to be considered. We will contact you as soon as a decision has been made!

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* 1. First Name:

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* 2. Last Name:

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* 3. Email:

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* 4. Medical School:

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* 5. Month/Year of Graduation:

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* 6. Are you graduating medical school within 5 years of start date?

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* 7. Current Address:

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* 8. Phone Number:

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* 9. Hometown:

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* 10. In the area of Family Medicine, what are your specific interests?

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* 11. Why did you choose to apply to Abington Family Medicine for a 4th year rotation?

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* 12. Do you have any failed rotations or remediated courses?

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* 13. Do you have more than one board failure (i.e. USMLE Step 1/2, Comlex Level 1/2)

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* 14. Can you provide up-to-date documentation for flu vaccine?

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* 15. Can you provide documentation for covid-19 vaccination?

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* 16. Please list 3 rotation start and end dates in order of preference. Rotations may be 2 or 4 weeks.

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