KH Observership Application

* First Name:

* Last Name:

* Email:

* Graduation Date:

* Medical School:

* Observership Site:

* Observership Start Date:

* Observership End Date:

* Name of Sponsor:

* Email of Sponsor:

* Why do you want to do an observership at Kettering Health?

* What do you hope to get from this experience?

* What are some of your outside interests and extra-curricular activities?

The following documents must be uploaded with this application for it to be considered:

(Only: PDF, DOC, DOCX, XLS or XLSX file types can be uploaded)

* STEP 2 CK / COMLEX Level 2 CE results:
ECFMG Certificate (if applicable):
* Current Curriculum Vitae (CV):
* Immunization Records Required by KH Employee Health: (Refer to the Observership Checklist for details)
* Signed Sponsor Agreement: (Refer to the Observership Checklist)