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Registration

 
 
Course Name: THE PRACTICE OF MEDICINE WITH HISPANIC PATIENTS: A Clinical Elective Rotation
Requirements for Enrollment:
  1. You must be a third or fourth year medical student in good academic standing with your current institution in order to enroll in this course.
  2. Fill in the required fields below on this page.
  3. Download the PDF application form at the bottom of this page, fill it out, and return it either by fax or via scanned email to Martha Rodriguez.
  4. Pay your tuition.

Note, that since this course is a credited clinical clerkship elective, you must receive authorization from your school in order to enroll and receive credit at your current institution.

Course Cost:   $2,425.00
*An application fee of $100.00 will be credited towards the total cost of the course
 


SECTION I: To be completed by applicant:

Applicant's Name:

Telephone:
     
Mailing Address:  
     
E-mail:                    
     
Currently enrolled as:    year medical student at (School Name):
     
(School Address)        
     
Clerkship for which application is made: 
     
Inclusive dates of course: From                       to    

If you wish to be contacted by us, please check this box, and Martha Rodriguez or another staff person will contact you directly.
 

                   

 
     
 

Download the registration form