AMPATH Kenya Clinical Rotation Interest Form (IU Trainees)

Thank you for your interest in AMPATH Kenya. Please complete the form below to indicate your interest in completing a rotation in Kenya during the next academic year.

Please note that the following form is for IU medical students, residents and fellows only. If you do not fit into one of these categories, please contact Victoria Eder at vneder@iu.edu for more information.

All fields below are required unless otherwise noted. For questions, please contact Victoria Eder.

Please select your trainee role:

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First Name:

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Last Name:

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Email Address:

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Thank you for your interest in AMPATH Kenya. This form is designated for Indiana University medical students, residents, and fellows. All others, please contact Victoria Eder at vneder@iu.edu.

What is your primary academic/clinical discipline?

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Other Discipline:

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Program Director First and Last Name:

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I am interested in participating in the Kenya elective during the following academic year:

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Other Academic Year:

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The Medicine in Kenya elective is available only to Phase 3 Year 4 students.

I confirm that I will be a Phase 3 Year 4 student during my anticipated rotation:

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Current Program Year:

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PLEASE NOTE:

Scheduling for this elective is done via lottery; those interested in completing the elective during the 2022-2023 academic year will be required to attend or send a proxy to a required lottery meeting, to be scheduled at a later date.

In addition to submitting this form, registration via iAbroad will also be required. As part of this form, you will be required to submit a personal statement and copy of your CV. Additional details will be sent via email.

All trainees will be invited to an orientation, typically held in the Spring.

Comments or questions? (optional)

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