URiM Visiting Sub-I Scholarship Application (2023)

For 2024: please use this link: tinyurl.com/URiMstipend 


The Department of Emergency Medicine at Harbor-UCLA Medical Center is committed to recruiting & training individuals who represent the diverse patient populations we serve and who are interested in becoming leaders of and advocates for their communities. 

We seek to enhance diversity within the specialty of Emergency Medicine and recruit leaders who are interesting in joining our efforts to develop departmental & hospital-wide initiatives and research related to diversity, inclusion, social determinants of health, implicit bias, health equity, and social justice. 

In support of this mission, we are excited to offer financial support to fourth-year medical students who are under-represented in medicine and are interested in a sub-internship in our emergency department. A scholarship amount of $2,000 will be awarded to offset costs of travel expenses and lodging. 

For more information about our program, please visit: https://emedharbor.edu/

If you have any questions, please contact us at harborEMDEI@gmail.com. 

First name *
Last name *
Email *
Phone number
Medical school *
Racial/ethnic identity *
Gender identity *
First-generation college student *
Please describe how your background and/or experiences (personal or extracurricular) have contributed to a commitment to working with diverse populations and historically-marginalized communities.

How does health justice along with diversity, equity, and inclusion align with your values and career goals? (400 word max) *
Please attach a copy of your CV. If you're unable to attach, please try the following: click get link at the bottom of the google form-> get a link of the same form with response -> open the link in a new tab -> submit CV.

If still unsuccessful, please email CV to harborEMDEI@gmail.com 
Add file
How did you hear about the visiting clerkship?
How did you hear about the scholarship?
Get link
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google. - Terms of Service - Privacy Policy

Does this form look suspicious? Report

Google Forms