Get Aviva Health Medical Student Rotation Request Application 2020

This guide provides a detailed overview of how to complete the Aviva Health Medical Student Rotation Request Application online. By following these steps, you can ensure that your application is filled out correctly and submitted successfully.

Follow the steps to complete your application online.

1. Press the ‘Get Form’ button to access the application form and open it in your preferred editor.
2. Begin by entering today's date in the designated field at the top of the form.
3. In the personal information section, input your full name, preferred gender pronouns, current address, city, state, zip code, cell phone number, and email address.
4. Navigate to the medical school information section. Fill in the name and campus location of your medical school, the name of your medical school coordinator or point of contact, and their contact information (phone number and email). Also, indicate your current status (3rd-year or 4th-year student) and expected graduation date.
5. If you are graduating this year, specify the specialty or specialties you are interested in applying to for residency. Answer whether you have taken and passed your board exams, and whether you passed them on your first attempt. Input your board scores for USMLE Step 1, Step 2 CK, and COMLEX Level 1 and Level 2 CE if applicable.
6. In the rotation request information section, select whether this rotation request is for a 3rd-year elective, 4th-year elective, or 4th-year audition rotation. Circle your requested discipline (Family Medicine, Pediatrics, Psych/Behavioral Health, or Women’s Health) and specify your preferred rotation dates.
7. Indicate if you have rotated through Umpqua Community Health Center Clinic(s) before and provide the relevant dates and assigned provider if applicable.
8. Answer whether you have completed any rotations in Roseburg or surrounding areas, and list the rotation and site/preceptor if applicable.
9. Finally, describe any clinic operating software or EMRs you are familiar with.
10. In the section for links to Oregon or Roseburg, provide information about any ties you may have to the region.
11. Review all information for accuracy. Once confirmed, save your changes, download, print, or share the form as needed, and submit it to the specified email addresses: dinglis@umpquachc.org or desireeinglis@chiwest.com.

Start filling out your Aviva Health Medical Student Rotation Request Application online today!