ࡱ> 02/ bjbjBrBr M  q     !!!!$E!aaaaa<<<jllllll$_9 <<<<<  aa< a aj<ja!FV0Ff <<<<<<< <<<<<<<<<<<<<<<< : Application for Year 1 & 2 Shadowing & Skills Experience Year 1 (August 28, 2006 to May 11, 2007, for May 14, 2007 to August 26, 2007 student must register in Med 518) Year 2 (August 28, 2006 to May 25, 2007, for May 28, 2007 to August 19, 2007 student must register in Med 528) Name: Grad Year: (Surname) (Given name) Email Address: Student ID: (Signature of Student) (Date) % shadowing experience only, no formal credit to be granted % 12 hour elective credit for Med 517 or Med 518 Fill in this section to describe your shadowing experience: Description of Experience: Location of Experience: Date of Elective: Preceptor's name: Preceptor's address: Telephone: RRH Signature: Date: UGME Approval: Date: Instructions regarding completion of this form: To receive approval for this experience, this form must be completed and submitted, 6 weeks prior to the experience, to Tamara Mitchell Schultz in the Office of Rural & Regional Health to be signed and returned to the Undergraduate Medical Education Office.    &/9;BCKLQRZ\abelmnstsisssshCJOJQJhHchCJOJQJhxJCJOJQJhHchCJOJQJh'jCJOJQJhHch?}HCJOJQJhHch62CJOJQJhHchHcCJOJQJhp5CJOJQJhHc5CJOJQJhK+n5CJOJQJh5CJOJQJh625CJOJQJ);  0 I J g h i x gd&O d`gd62 &dPgd62  gd62 pd`gd62  d&dPgd62gd62$a$gdHc$a$gd $da$gd62 % / 0 I J X Y f g h i ( : ˵˞˔vlv_RhhCJOJQJhh62CJOJQJh<<CJOJQJh&OCJOJQJh62CJOJQJhk#aCJOJQJhK+nCJOJQJh h CJOJQJhCJOJQJh62CJEHOJQJh CJOJQJh62CJOJQJhxJCJOJQJhHcCJOJQJh'jCJOJQJhHchHcCJOJQJ V X ( ) ; < ^ _ o p { | dgd62d&dPgd62gd62 &dPgd62: < P R V X ( < ^ _ o |  2 e t u ƻлааааЦЦЏЄzpzhpCJOJQJhJMSCJOJQJh625CJOJQJhK+nCJOJQJhK+nhK+nCJOJQJh{CJOJQJh62>*CJOJQJh>*CJOJQJhCJOJQJh62CJOJQJhh62CJOJQJhhCJOJQJh5CJOJQJ, Y Pdgd` PdgdMN Pdgdgd62 |ùh9hCJOJQJhhCJOJQJhJMShMNOJQJaJhJMShOJQJaJUh\CJOJQJh62CJOJQJ Tamara Mitchell Schultz, Administrative Assistant Undergraduate Medical Education Office Office of Rural & Regional Health Faculty of Medicine & Dentistry 205 College Plaza 2-45 MSB Phone: 492-0582 Phone: 492-6350 Fax: 492-8191 Fax: 492-9531 K@P PP&P:p|<0/ =!"#$% Dp^ 2 0@P`p2( 0@P`p 0@P`p 0@P`p 0@P`p 0@P`p 0@P`p8XV~_HmH nH sH tH D`D 62NormalCJOJQJ_HmH sH tH DA D Default Paragraph FontRiR  Table Normal4 l4a (k (No List HH { Balloon TextCJOJQJ^JaJPK![Content_Types].xmlj0Eжr(΢Iw},-j4 wP-t#bΙ{UTU^hd}㨫)*1P' ^W0)T9<l#$yi};~@(Hu* Dנz/0ǰ $ X3aZ,D0j~3߶b~i>3\`?/[G\!-Rk.sԻ..a濭?PK!֧6 _rels/.relsj0 }Q%v/C/}(h"O = C?hv=Ʌ%[xp{۵_Pѣ<1H0ORBdJE4b$q_6LR7`0̞O,En7Lib/SeеPK!kytheme/theme/themeManager.xml M @}w7c(EbˮCAǠҟ7՛K Y, e.|,H,lxɴIsQ}#Ր ֵ+!,^$j=GW)E+& 8PK!Ptheme/theme/theme1.xmlYOo6w toc'vuر-MniP@I}úama[إ4:lЯGRX^6؊>$ !)O^rC$y@/yH*񄴽)޵߻UDb`}"qۋJחX^)I`nEp)liV[]1M<OP6r=zgbIguSebORD۫qu gZo~ٺlAplxpT0+[}`jzAV2Fi@qv֬5\|ʜ̭NleXdsjcs7f W+Ն7`g ȘJj|h(KD- dXiJ؇(x$( :;˹! I_TS 1?E??ZBΪmU/?~xY'y5g&΋/ɋ>GMGeD3Vq%'#q$8K)fw9:ĵ x}rxwr:\TZaG*y8IjbRc|XŻǿI u3KGnD1NIBs RuK>V.EL+M2#'fi ~V vl{u8zH *:(W☕ ~JTe\O*tHGHY}KNP*ݾ˦TѼ9/#A7qZ$*c?qUnwN%Oi4 =3ڗP 1Pm \\9Mؓ2aD];Yt\[x]}Wr|]g- eW )6-rCSj id DЇAΜIqbJ#x꺃 6k#ASh&ʌt(Q%p%m&]caSl=X\P1Mh9MVdDAaVB[݈fJíP|8 քAV^f Hn- "d>znNJ ة>b&2vKyϼD:,AGm\nziÙ.uχYC6OMf3or$5NHT[XF64T,ќM0E)`#5XY`פ;%1U٥m;R>QD DcpU'&LE/pm%]8firS4d 7y\`JnίI R3U~7+׸#m qBiDi*L69mY&iHE=(K&N!V.KeLDĕ{D vEꦚdeNƟe(MN9ߜR6&3(a/DUz<{ˊYȳV)9Z[4^n5!J?Q3eBoCM m<.vpIYfZY_p[=al-Y}Nc͙ŋ4vfavl'SA8|*u{-ߟ0%M07%<ҍPK! ѐ'theme/theme/_rels/themeManager.xml.relsM 0wooӺ&݈Э5 6?$Q ,.aic21h:qm@RN;d`o7gK(M&$R(.1r'JЊT8V"AȻHu}|$b{P8g/]QAsم(#L[PK-![Content_Types].xmlPK-!֧6 +_rels/.relsPK-!kytheme/theme/themeManager.xmlPK-!Ptheme/theme/theme1.xmlPK-! ѐ' theme/theme/_rels/themeManager.xml.relsPK] q:    8@0(  B S  ?s &/::;BCLQRZ\a%/IIX[ffgh #@CCDD.@wyS`aannppss"&, <<?}HxJMNJMSk#aHcK+nRp9t&Oo`F62gIp`\n|{:'j"qs@x4yqp@p p@p8@UnknownG* Times New Roman5Symbol3. * ArialABook Antiqua=" HelvArial5. *aTahomaA$BCambria Math"hJ J 2f  !24doo3HP)?"2!xx/APPLICATION FOR YEAR 1 ELECTIVE (CLASS of 2009)Michelle PhillipsFoMDOh+'0 ( 8D d p | 0APPLICATION FOR YEAR 1 ELECTIVE (CLASS of 2009)Michelle PhillipsNormalFoMD2Microsoft Office Word@F#@i]@@՜.+,0, hp  Unversity of ϲ o 0APPLICATION FOR YEAR 1 ELECTIVE (CLASS of 2009) Title  !"#$%&()*+,-.1Root Entry F,°31TableWordDocumentMSummaryInformation(DocumentSummaryInformation8'CompObjy  F'Microsoft Office Word 97-2003 Document MSWordDocWord.Document.89q