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CLERKSHIP APPLICATION: IN HIS IMAGE FAMILY MEDICINE RESIDENCY
Clerkships are available for current MSIV or OMSIV students who attend US medical schools. We are unable to offer rotations for IMGs.
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Full Name
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Address
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Phone number
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Email Address
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Requested Clerkship beginning and ending dates (We accept students Aug-Jan. Other months are allowed upon a case by case exception)
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Your answer
Medical school name with city/state
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Your answer
Expected graduation month/year
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Your score(s) on each Step of the boards you’ve completed and number of attempts needed to pass (we accept both USMLE and COMLEX scores)
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How did you hear about In His Image
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Describe your background, aspirations and why you are applying to In His Image
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Area of Medical Interest (mark one or two that you want to explore)
Rural
Urban
International short-terms
International long-term
Other:
Do you plan to apply to In His Image for the upcoming MATCH?
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Briefly describe your spiritual journey and include some of your faith-based activities or experiences
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Name of your current place of worship
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Name and phone number of a leader at your worship center who could give us a recommendation about you
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