Student Rotation Application

Thank you for your interest in CBHA. With clinics located in Othello, Connell, and Mattawa our mission is to provide equal access to quality healthcare to all persons regardless of age, sex, color, ethnicity, or the ability to pay.

~ Personal Information ~

Student's First & Last Name*

*Legal Name

Student's Phone/Cell Number:*

*Best Contact Number

Phone

Student's Email:*

*Preferred Email Address

Hometown:*

Expected Graduation Date:*

~ School Information ~

School/University*

Program:*

Program Contact:*

Year in School:*

Anticipated Rotation Start Date:*

Anticipated Rotation End Date:

Total Number of Hours Needed*

Please enter the total number of hours you will need with a CBHA preceptor during this anticipated rotation.

Do you require housing?*

Select

~ Questionnaire ~

What special qualities do you possess?*

Why did you choose the healthcare field?*

Qualities or traits you look for in a physician?*

What three things would you change in society?*

What do you hope to achieve in your career?*

File Upload: Current CV/Resume (REQUIRED) & Letter of Good Standing from School/Program*

Drag and drop files here or

Send me a copy of my responses

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