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Clerkship Application
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Name
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Email
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Address
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City
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State
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Zip
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Phone
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School
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Graduation Year
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Preferred Dates
Please include your preferred start date and end date; both your first choice and second choice.
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Area in medicine of primary interest to you:
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Explain briefly your interest in the Casper program and Wyoming:
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What is your interest in rural medicine and the underserved population, as that is our program’s main focus:
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Please provide other information or questions you may have:
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