Application for Shadowing Experiences

Important Notice:
We encourage applicants to submit the Future MD application form only when all required documents are complete and up to date. Applications missing any documents will not be considered. If you have any questions, please contact us at admisiones@crepspr.org.

Full Name

Age

Personal Email (not affiliated with an institution)

Phone Number

Town of Residence

What Is Your Gender?

What Is the Highest Level of Education You Have Completed?

What Career Do You Aspire to Pursue?

What Is Your Employment Status?

Declaration of Interest Essay (800–900 words)

COVID-19 Vaccination Evidence (PDF)

Immunization Record (PVAC-3) (Green Vaccination Document) (PDF)

ID with Photo (License or Passport Preferred) (PDF)

CV (Undergraduates) or Resume (High School Students) (PDF)

School Transcript (PDF only)

Certificate of Good Conduct (High school students without a license: please include a letter from your parent or a document explaining your situation.)(To download the certificate, visit https://www.pr.gov/antecedentes-penales)(PDF)

Health Certificate (Must be up to date and required to begin the program. If in process, leave blank) (PDF)

Have You Previously Applied for the Future MD Shadowing Program?

Have You Previously Applied for CREPS Experiences?

Select Your Week of Availability

Select Your White Coat Size

I have read and understand the conditions previously presented and certify that the information provided is true. If accepted to participate, I will comply with the foundation’s rules and expectations. I accept to receive via email further information about relevant opportunities related to my professional goals. I confirm that I have my own transportation and housing arrangements for the duration of the program. I hereby confirm my commitment to participate in the program on a daily basis (if accepted), until its completion, without any exceptions. This includes attendance on May 29th (initiation day in Dorado) and for the full two-week program.

Metro Pavia Clinic and CREPS:
Future MD Shadowing Program Form

Links

Contact

Metro Pavia Clinic and CREPS: Future MD Shadowing Program Form

Links

Contact

Metro Pavia Clinic and CREPS:
Future MD Shadowing Program Form