University of Washington s1
Applicant# ______
(leave this blank)
University of Washington
International Health Group
INTERNATIONAL HEALTH OPPORTUNITIES PROGRAM (IHOP) APPLICATION
· Application and Letter of Recommendation (LoR) are due by noon on 11/01/05 to Daren Wade at .
· If we do not receive the LoR by the application deadline, we will be unable
to consider your application for IHOP.
Please indicate your first year site (circle one):
Alaska Montana Pullman/Idaho Seattle Wyoming
Name / UW ID#Current Address / Tel#
Permanent Address / E-mail
Please check: / Yes / No
I am a first year medical student at the University of Washington
I plan to pursue a career in international health and have a long-term commitment to working with underserved populations worldwide.
I understand that this is not an application for funding, but an application for funded international health opportunities.
You are required to submit a letter of recommendation from a faculty person you have worked with closely at the UW or other academic/research institution. A letter of recommendation will be sent by:
Name / Tel#Title
Address / Fax#
Undergraduate education
Institution / Degree / Year / Honors(eg. Magna Cum Laude)
Graduate education (not including medical school, unless you are an MD/PhD)
Institution / Degree / Year / Earned HonorsExtracurricular activities
College / Graduate school / Medical school / OtherEmployment
Position / Description of Responsibilities / YearsPublications
Foreign Languages
rate fluency in each language spoken 1 = some, 2 = intermediate, 3 = advanced, 4 = native
Language / Reading / Writing / Hearing / Speaking
Rank IHOP sites in order of preference (1 = highest). Do not rank sites where you do not want to go, or for which you do not have the necessary foreign language skills. Peru and Mexico require an advanced level of Spanish.
* Please note Mexico is a 4-week experience.
Please answer the following questions in an essay format.
You may take up to 3 pages to answer these questions, using as much space as you would like for each within that page limit. Do not change the font or character size.
1. List and describe all your experiences for each of the following as is applicable (do not include vacations):
(a) Working with underserved populations outside the United States
(b) Working with underserved populations inside the United States
(c) International health research or job
(d) Public health research or jobs
(e) Other medical or health-related research or jobs
2. Describe your future career plans.
(a) How does international health fit into your future career?
(b) What field of medicine do you plan to pursue (if known)?
3. How will participation in IHOP advance your future career goals? What do you hope to gain from this experience?
4. Is there anything else that we should know about you?
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