Sub-Intern Application

Smoky Hill is dedicated to training physicians for Rural Kansas. Because of this, we ask that you answer the following questions by submitting the application listed below. We want to guarantee that we are the right fit for you!

Name(Required)

First Last

Address(Required)

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Email(Required)

Phone(Required)

May we text you?(Required)

Yes

Medical School(Required)

Graduation Year(Required)

First Choice – Start Date(Required)

MM slash DD slash YYYY

First Choice – End Date(Required)

MM slash DD slash YYYY

Second Choice – Start Date(Required)

MM slash DD slash YYYY

Second Choice – End Date(Required)

MM slash DD slash YYYY

Third Choice – Start Date(Required)

MM slash DD slash YYYY

Third Choice – End Date(Required)

MM slash DD slash YYYY

How did you hear about our program?(Required)

Please describe where you have been (or are now) doing clinical rotations.(Required)

Please type in where your current rotations are: rural, urban, suburban, university, or residency practice(s) settings?(Required)

What are you looking for and what do you want to accomplish in our Sub-Internship program?(Required)

Is there anything else you'd like to tell us about yourself?

I am planning to go into family medicine.(Required)

Yes

USMLE II/COMPLEX II – Passed(Required)

Yes

Clinical skills – Passed(Required)

Yes

USMLE I/ COMPLEX I – Passed(Required)

Yes

Questions?

If you have any questions, please contact:

Krista Galvan
Residency Program Manager

Smoky Hill Family Medicine Residency Program
651 E. Prescott Road
Salina, KS 67401

kgalvan@salinahealth.org • 785-825-7251

Smoky Hill Family Medicine Residency

651 E. Prescott Road | Salina, KS 67401
785-825-7251

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