Global Pediatrics Track Enrollment Form 2023-2024

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- Please fill out as much information as possible - the more information you provide, the more we can offer you (mentorship, research opportunities, etc.)

- Questions with a * are required for enrollment form completion.

- Please send a copy of your CV to edanich@umn.edu.

First Name *

Last Name *

Phone number - This will be used to add you to the Global Pediatrics Track WhatsApp group so you can be notified of Track events and other important information.

UMN email *

Residency Program *

Peds

MedPeds

Have you lived or worked outside the US? *

Yes

Briefly describe or list when you were abroad, the setting (rural or urban), type of work (medical care, public health, research or community base) etc.

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