Medical Student Electives - Application Forms

Online Application Form

Fields marked with * are required

Personal Details

Name *

Address *

Postcode *

Telephone *

Email address *

Date of birth *

Select Placement *
ASHWINI SVYM CIDS Rwanda

Preferred Departure Dates: 1)		Preferred Return Dates: 1)
2)		2)

Education and Experience

Higher education

Dates *	Dates
University/College *	University/College
Exam results to date *	Exam results to date
Year of Study: *

Paid work experience (if any)

Dates	Dates
Employer's Details	Employer's Details
Job Description	Job Description

Voluntary work experience (if any)

Dates	Dates
Description of work/responsibilities	Description of work/responsibilities

About You

Do you have any other qualifications or skills? Please give brief details.

What are your hobbies/interests?

Do you have any special needs? e.g. disability, health problems.

What do you want to get out of this experience?

What previous travel experience do you have?

What are your future educational plans?

Which aspects of medicine are you most interested in?

Do you have a project you will pursue? (Give details)

References (please supply two)

Name of Referee *	Name of Referee *
Job Position *	Job Position *
Organisation/Address *	Organisation/Address *

Working Holidays Abroad

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Online Application Form