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Resident Engagement & Training for Underserved & Rural Needs (RETURN) Rotation Interest Form
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1.
Name
(Required.)
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2.
Email Address
(Required.)
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3.
Program
(Required.)
4.
PGY
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5.
Areas of interest in rural or underserved:
(please select all that apply)
(Required.)
Rural / Underserved rotation
Resident as Teacher
Potential future rural practice
Concept to Community (C2C) contest
Global and Rural Health Scholars Program
6.
Additional Feedback/Comments:
Ex: I'm from a small town and bring relevant experience....
Ex: I would like to explore Blanding, Utah....
