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2015 Summer Externship/Research Application
Note: Application forms must be returned to Faye Dawson Brock in the UCR School of
Medicine no later than April 17, 2015. All applications must be typewritten. Handwritten
applications will be returned. Incomplete applications or applications without adequate answers
to the questions on the following pages will not be considered. All students participating in
the Summer Externship program are required to have an updated TB (PPD), CPR
certification, driver license (or official photo ID). A copy of health clearance form will be
provided by the Office of Student Affairs.
Time period is 6 weeks: Monday June 22, 2015 – Friday, July 31, 2015
Name:
Complete Address:
Cell Phone:
Other:
Social Security Number:
Indicate clinical location or research lab preference, if any. Number your preferences 1 through
4 and/or 1 through 8 (1 being the most desirable location). Please note that we do take these
preferences into account. However, we cannot guarantee that a student will be placed in any
particular location. Each externship/research position carries a stipend for $3,000.
Riverside Medical Clinic (2 position available)
Kaiser Permanente Medical Center (4 position available)
Riverside County Regional Medical Center (6 positions available)
Renuance Plastic Surgery Clinic (2 positions available)
Research, Dr. Declan McCole (1 position available)
Research, Dr. Monica Carson (1 position available)
Research, Dr. Ilhem Messaoudi (1 position available)
Research, Dr. Christian Lytle (1 position available)
Research, Dr. David Lo (1 position available)
Research, Dr. Iryna Ethell (1 position available)
Research, Dr. Meera Nair (1 position available)
Research, Dr. Frances M. Sladek (1 position available)
1. Why do you want to participate in the Summer Externship Program?
2. What do you hope to gain from this experience? (Limit your response to the space
below.)
3. What accomplishments or contributions have you made during your first year of medical
school that you would like the faculty to consider in ranking your application? (Limit
your response to 200 words or less. Your answer will be available to all faculty
members.)