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Medical Student and Clerk Rotation Evaluation v2

1.Rotation Information

1.Please fill out the following information:(Required.)
2.In which community you did your rotation?(Required.)
3.In which clinic/hospital you did your rotation?(Required.)
4.Rotation Dates:(Required.)
Start Date:
Finish Date:
5.University:(Required.)
6.Which rotation/s you had done during your rotation dates?(Required.)
7.Level of Training(Required.)
8.Year in Program(Required.)
9.Which community choice did you receive?(Required.)
10.Please identify your main reason(s) for participating in a ROMP-facilitated rotation:(Required.)