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Preventive Medicine Resident Practicum Program Application

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APPLICATION DEADLINE: Monday, March 2, 2010 (Midnight)

Directions:
Provide all information, filling out the form as completely and accurately as possible.  You only need to submit the form once, even if you are applying to both AHRQ and ODPHP.  Please review the form and collect the information before starting; information on incomplete forms will not be retrievable.

Office

Personal Information

Residency Program

Availability

 1st Choice2nd Choice3rd Choice
January
February
March
April
May
June
July
August
September
October
November
December
Please list your rotation period preferences in two- to three-month intervals.

Credentials


Letter of Recommendation

A letter of recommendation is required from the Residency Program Director to state support for the applicant as a qualified candidate for the APTR Preventive Medicine Resident Practicum Program.  Recommendations written by the Director must be attached as a PDF below.

Sample of Scientific Writing (AHRQ)

Please enclose a sample of scientific writing not to exceed two pages:
  1. The sample may be from published or unpublished sources.
  2. You must be the primary author of the document.  If there are multiple authors, please clearly identify which pieces were written by you.
  3. The sample must be on a health-related topic, preferably in prevention, public health, or health policy.
  4. Bibliographies do not count toward the two page maximum length.

Applicant Statement of Interest (ODPHP)

Please enclose a statement not to exceed two pages describing:
  1. The subject matter area(s) on which you would like to focus during a rotation at ODPHP
  2. The reasons for your interest in and prior experience in these subject area(s)
  3. The personal and professional goals for your residency rotation at ODPHP

Applicant Affirmation

By submitting this form, I certify that I am eligible to apply to the APTR Preventive Medicine Practicum Program and the information that I have provided in this application is complete and accurate.

Questions

For more information or questions about this application, please contact:
202.463.0550, ext. 123 or training@aptrweb.org
* Indicates Response Required