POM HABLE and PBL HABLE Application
Required course for BHT Group I
Last Name
Your answer
Middle Name
Your answer
First Name
Your answer
Complete student ID number
Your answer
List most common email address
Your answer
Phone number
List phone number so that Dr. Perez can contact you for the oral proficiency test
Your answer
Group I - Prerequired Courses
Please check if applying for one or both
Spanish Fluency
Are you a fluent Spanish speaker?
Oral Proficiency Test
Have you been tested for Spanish oral proficiency?
Oral Proficiency Certification
Name the agency or institution that certified you in Spanish oral proficiency
Your answer
Medical Spanish Terminology
Do you have knowledge in medical Spanish terminology
Medical Spanish Terminology
If you checked yes to having knowledge in medical Spanish terminology, please indicate name of institute you received formal training
Your answer
Medical/Health Experience(s)
List your experiences in the past (mission trips, research, clinical shadowing, etc.). Include city, county, state, and country if outside of US. Add reason why you pursued the experience(s).
Your answer
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