2023 Summer Externship Application Co-Sponsored By: The Family Health Foundation of Missouri and The American Academy of Family Physicians Foundation. The deadline to apply is Monday, March 13, 2023. Question Title * 1. Student Information Name Birthdate Mailing Address City State ZIP Code Email Address Phone Number Question Title * 2. Name of the Missouri Medical School You Attend Question Title * 3. Current Year of Medical School MS1/OMS1 MS2/OMS2 MS3/OMS3 MS4/OMS4 MS5/OMS5 MS6/OMS6 Question Title * 4. Preference for Externship Location 1University of Missouri Kansas City - University Health Family Medicine Residency in Kansas City, MOMove up University of Missouri Kansas City - University Health Family Medicine Residency in Kansas City, MOMove down University of Missouri Kansas City - University Health Family Medicine Residency in Kansas City, MO2Research Family Medicine Residency in Kansas City, MOMove up Research Family Medicine Residency in Kansas City, MOMove down Research Family Medicine Residency in Kansas City, MO3University of Missouri - Bothwell Family Medicine Residency in Bothwell, MOMove up University of Missouri - Bothwell Family Medicine Residency in Bothwell, MOMove down University of Missouri - Bothwell Family Medicine Residency in Bothwell, MO4Capital Region Medical Center Family Medicine Residency in Jefferson City, MOMove up Capital Region Medical Center Family Medicine Residency in Jefferson City, MOMove down Capital Region Medical Center Family Medicine Residency in Jefferson City, MO5University of Missouri – Columbia Family Medicine Residency in Columbia, MOMove up University of Missouri – Columbia Family Medicine Residency in Columbia, MOMove down University of Missouri – Columbia Family Medicine Residency in Columbia, MO6Saint Louis University Family Medicine Residency in St. LouisMove up Saint Louis University Family Medicine Residency in St. LouisMove down Saint Louis University Family Medicine Residency in St. Louis7Mercy Family Medicine Residency in St. Louis, MOMove up Mercy Family Medicine Residency in St. Louis, MOMove down Mercy Family Medicine Residency in St. Louis, MO Question Title * 5. Please list any professional healthcare or student organizations besides MAFP that you are a member of. Question Title * 6. Please select the number that reflects your current level of interest in entering a family medicine residency program. 0 (Not interested) 10 (Certain) Clear i We adjusted the number you entered based on the slider’s scale. Question Title * 7. Please explain why you are interested in family medicine (in 500 words or less). Or attach a file. Question Title * 8. Please explain why you want to participate in the Student Externship Program (in 500 words or less). Or attach a file. Question Title * 9. Upload Other Supporting Documents (In one file) PDF, DOC, DOCX, PNG, JPG, JPEG, GIF file types only. Choose File No file chosen Remove File Upload Other Supporting Documents (In one file) Submit Application