Application and cover sheet for OGH Elective placements*

______

Name: ……………………………………………………………………………

SID: …………………...... DOB: …………………...... Citizenship: ......

Email: …………………...... Mobile: …………………......

Clinical School: ……………………………………… Honours: Yes / No Male/Female

List in order of preference which country and institution you wish to undertake your international experience through the OGH International Experiences program and for how long**. It is expected that you will take up any preferences listed.

1 Number of weeks: 4 / 8

2 Number of weeks: 4 / 8

3 Number of weeks: 4 / 8

* Placements at Karolinska, Copenhagen & NUS have closed.

** OGH placements in the USA and Europe have to be undertaken for 8 weeks. It is highly encouraged that you select 8 weeks for all other placements but 4 weeks will be considered.

List 2 rotations you are interested in undertaking 1...... 2......

Please request for the following section to be signed off by your Clinical School:

I confirm that ______is a student of good standing at ______Clinical School and currently academically able to undertake an international elective during the Elective Term in 2015/16. This Clinical School will endeavour to notify the Office for Global Health as soon as possible should there be any changes to this status during the year.

______

Signature: Associate Dean, Clinical School

Complete applications:

-  should be emailed to by 9am Monday, 18th May 2015.

-  received after the deadline will not be accepted. Extensions cannot be permitted.

-  must have the subject heading ‘OGH Elective Placement’ (without this subject heading your application may not be processed).

-  must include CV with photo, letter of approval from Honours Sub Deans (if applicable) and response to Application Task.

-  must be in one attachment only (either Word or PDF not Zip) and saved as OGH_Placement_*your name*

Application tasks

Please write your application addressing the following (limit your responses to no more than 500 words in total and include word count at the end):

1.  Describe the potential benefits for you personally and for Sydney Medical School from participating in this exchange. Your response should demonstrate that you have done some research on the placement and on how you may contribute.

2.  Clearly articulate the learning goals for your elective term and how you plan to achieve them.