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Kettering Med Ed Home  Residencies &  Fellowship Programs  Students  Apply Now  CME  Popoway  Discover Kettering,  Dayton & Cincinnati  Contact Us      Kettering Medical Education      3535 Southern Blvd.      Kettering, Ohio 45429      Phone: (937) 395-8609                    (800) 203-8925      Fax: (937) 395-8023 Summer Externship Application Email Us    |  Print    Apply Now - 2012! Name: Phone (including area code): Email Address: Date of Birth: Medical school you are currently attending: School Address Street: City: State: Zip: Email: Hometown Address Street: City: State: Zip:  Important:   Where we can reach you in the summer? Phone # and/or email: Undergraduate institution you attended: Need a room for externship: Yes    No Need a car for externship: Yes    No Emergency contact & phone number: NOTE:   Students will need a valid driver's license and insurance coverage to use the Med Ed loaner car. Please select three time frames from the list below. You must be available for any of the dates you choose, even if they are not your first choice. June 11 - June 22: First   Second   Third June 25 - July 6: First   Second   Third July 9 - July 20: First   Second   Third July 23 - Aug 3: First   Second   Third Aug 6 - Aug 17: First   Second   Third  (SS# will be required when accepted) Choose 5 subspecialty preferences, with 1 being the most favored. (Other rotations may be requested) Behavioral Health 0 1 2 3 4 5 Cardiology/Cath Lab 0 1 2 3 4 5 EKG/ECHO 0 1 2 3 4 5 Hematology/Ocology 0 1 2 3 4 5 HIV Clinic/Infectious Diseases 0 1 2 3 4 5 Pulmonary/ICU 0 1 2 3 4 5 Dialysis 0 1 2 3 4 5 Radiology 0 1 2 3 4 5 Choose 5 Additional Opportunities, with 1 being the most favored. (Other rotations may be requested) Emergency Medicine 0 1 2 3 4 5 Pathology/Laboratory 0 1 2 3 4 5 Nuclear Medicine 0 1 2 3 4 5 Surgery Observation 0 1 2 3 4 5 Good Neighbor House (indigent clinic) 0 1 2 3 4 5 Sycamore Primary Care 0 1 2 3 4 5 Sports Medicine 0 1 2 3 4 5 Labor & Delivery 0 1 2 3 4 5 Peds Clinic 0 1 2 3 4 5 Letter of Application: What do you hope to gain from this experience? What healthcare/hospital experience have you had? What are some of your outside interests and extra-curricular activities? Further qualifications, reasons for application, or experience: Image Code: Enter this number »»  Contact: Jenny Fitzpatrick - (937) 298-3399 ext. 55997 - Email Jenny

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