Application Form – STSG 2013 Medical Brigades | UK

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Application Form – STSG 2013 Medical Brigades

Shoulder to Shoulder Global is offering two multidisciplinary service health brigades to Ecuador in the summer of 2013. Please check the dates you are available to go. Since we anticipate a large number of applicants, checking both options will increase your chances of being selected.

Please note:The 2013 brigades to Ecuador are full. Applications are only being accepted for physicians, nurse practitioners and Spanish/English interpreters.

Brigade Dates *

May 10-19

August 2-11

Either

Please select your preference.

First Name *

Last Name

Status *

UK Student

UK Staff

UK Faculty

Other

Specify if other

Phone Number *

Primary Email *

Campus Email

Is this your first trip with STSG to Ecuador? *

Yes

If no, when was your previous trip? If yes, how did you find out about us? *

Please rate your Spanish speaking/comprehension ability. *

Equipment and supplies that you need or can provide:

Additional Info if you are a UK Student

Student ID

Year

Freshman

Sophomore

Junior

Senior

Graduate Student

Occupation / Education Info

College and Department

(i.e. College of Arts and Sciences, Health Sciences, Physical Therapy)

What is your occupation/what skills do you offer that would add value to the brigade?

(i.e. I'm an Orthopedic Surgeon, I'm a Second Year Resident specializing in Pediatrics, I'm a junior majoring in Spanish, No specifics but eager to help)