How to Apply & Application

Applications closed due to COVID-19.

Program Requirements and Application Process

To participate in the Global Health Program residents must meet the following requirements:

The resident must be in good standing at their own residency
Documented approval from their Residency Program Director
Possess medical and travel insurance
Possess a valid passport
Some electives require the resident be at a PGY2 or higher level and have a valid California Medical License if traveling without Kaiser Permanente staff physicians
Present your international clinical elective experience to your residency program upon completion
Complete our Pre-Departure Learning Module
Must have supervising physician at your away elective site
The medical elective abroad must be completed in the academic year of July 2019 through June 2020
Complete the online application and provide the following documents
- - Complete the Release and Hold Harmless Form(pdf)
  - Complete the KP Global Health Code of Conduct (pdf)
  - Complete the Media Release (pdf)
  - Complete the Pre-Departure Learning Module and sign the acknowledge tab and submit

Funding

To participate in our Global Health Program it is the resident’s responsibility to self-fund their trip. You are welcome to research and apply to outside resources for funding as well. Currently we have ten Global Health stipend ($1,000 per stipend) to award this academic year (August 2019 through June 2020). Applications are now being accepted until January 10th, 2020 and the ten finalist will be announced by January 20th, 2020. Stipend winners are based on the merit of their application, current or future awards/grants/scholars received for your trip, and must complete all requirements listed above. The essay questions in your application are weighed heavily, and should be answered thoughtfully. The stipend will not be awarded until all the requirements are met within this academic year, and include the following.

Complete the trip you described in your application between August 1, 2019 through June 30, 2020.
Upon completion of the trip you must present on your experience to your fellow classmates during a didactic session.
You must provide itemized travel receipts totaling up to $1000 to Kelly Demski.

If a finalist fails to meet all the requirements within this academic year the stipend will be awarded to a runner-up applicant.

Good luck!

Application For Global Health Elective

Please complete the form below. You can save the form to finish later by clicking the "save and complete later" button.

Step 1 of 7

I. Personal Information
Name
NUID
Phone Number
Email
Residency/Fellowship Program Name
Post Graduate Year
Program Location
Program Director
Choose one*
- MD
- DO
Are you currently licensed or will be before the elective start date?*
- Yes
- No
License Number
Expiration Date
Fluent Languages Spoken
Passport number
Expiration date

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II. Emergency Contact Information
Name
Relationship to you
Phone (home)
Phone (work)
Address

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III. Elective Site Information
Organization Name
Organization Address
Organization Phone
Organization Email
List the name of your supervising physician abroad:
Supervising physician’s phone number:
Physician's Email
Organization Website
Practice Elective Location (City & Country)
Anticipated Start Date
Anticipated End Date

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IV. Past International Health Experience
List and briefly describe any relevant research, experience, volunteer, and/or employment history (international work or travel; applicable training in community health or primary care; cross-cultural experiences, “people oriented” or other volunteer work). Please note time commitment for each (total hours, hours/week, number of weeks worked, etc.).
Experience 1
Experience 2
Experience 3

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If you are also applying to be considered for our Global Health Stipend please complete section V.
V. Global Health Stipend Essay Questions
1. Describe your motivation for and interest in your proposed global health elective/experience. What do you hope to gain from this experience? How do your past experiences demonstrate your ability to make this elective successful?
2. Anticipated effects of your elective/experience: How will your elective/experience serve the needs of the community in which you will be working? What kind of long-term effect do you anticipate, if any?
3. How will you "bring your project back" to Kaiser community? (Education, presentations, encourage discussion on health issues in this country, etc.):
4. What are some of the potential challenges and pitfalls of electives abroad, and how do you plan to prepare for them?
5. Have you or will you be receiving another source of funding (e.g. awards, grants, scholars) for this medical elective? If yes, what is the source and amount?

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Supplemental Documents
Please upload the following completed forms in the box below:
- Release and Hold Harmless agreement form
- KP Global Health Code of Conduct
- Media Release
- Email or Letter of Recommendation from Program Director
File Upload
Drop files here or

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Signature
Use your cursor to write your signature in the box below
Type Full Name
Date
Untitled
Untitled

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Global Health Program

How to Apply & Application

Program Requirements and Application Process

Funding

Application For Global Health Elective

Step 1 of 7

I. Personal Information

II. Emergency Contact Information

III. Elective Site Information

IV. Past International Health Experience

If you are also applying to be considered for our Global Health Stipend please complete section V.

Supplemental Documents