Please complete the below application for consideration for an audition rotation with the MSI Family Medicine Residency Program at Saint Alphonsus Medical Center - Nampa.

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* 1. Full Name

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* 2. Preferred Name

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* 3. Preferred Pronouns

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* 4. Email Address

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* 5. Contact Phone Number

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* 6. Current Mailing Address

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* 7. Medical School

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* 8. Medical School Matriculation Date

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* 9. Expected Date of Graduation

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* 10. Please rank your desired rotation dates

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* 11. Have you ever taken a leave of absence from medical school?

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* 12. If you answered "yes" to the above question, please provide an explanation here.

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* 13. Are you pursuing a residency in Family Medicine?

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* 14. Do you have any personal connections to Idaho or the surrounding region?

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* 15. Please provide a short explanation (up to 200 words) of your interest in our Family Medicine Residency Program.

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* 16. Please describe (up to 200 words) your future medical practice (outpatient, inpatient, OB, full-spectrum, etc.).

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* 17. Our mission as a program and institution is to provide comprehensive medical care to our rural and underserved communities. Please describe (up to 200 words) how our mission resonates with you and how you have demonstrated your commitment to care for this patient population.

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* 18. Please provide a short description (up to 200 words) of how you have demonstrated adaptability and resilience and how this can translate to your practice of medicine.

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* 19. Please upload a current copy of your Curriculum Vitae (CV).

PDF, DOC, DOCX, PNG, JPG, JPEG, GIF file types only.
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* 20. Please upload a copy of your USMLE and/or COMLEX transcript.

PDF, DOC, DOCX, PNG, JPG, JPEG, GIF file types only.
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