Global Health Elective Application Form

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I agree, acknowledge, and understand the Acknowledgement of Global Health Elective Conditions listed below

Acknowledgment of Global Health Elective conditions

A. I understand that in order to have a well prepared and successful Global Health Elective rotation I need to begin preparation of my paperwork and pre travel requirements as soon as I am notified by my program director that I have been selected for a rotation slot. Normally travel prep begins 3-6 months prior to travel. Contact Ali Musani email

B. I understand that there are safety and health risks inherent with traveling to and working at the Hospital and the clinic.

C. I agree that I will not take personal vacation during the month that I have selected to do my Global Health elective rotation

D. If I am selected for one of my chosen months to do the Global Health elective rotation, I will ensure that I fulfill that obligation in order to provide the continuity of care for the underserved populations at that site, unless there is an exceptional reason (severe illness, death, or a serious impediment) that precludes me from doing the rotation. If I need to reschedule my rotation I will contact my Global Health liaison of the program and Dr. Ali Musani.

NOTE: Please send your CV to Ali Musani, after clicking on the submit button.

Department of Medicine (SOM)

CU Anschutz

Academic Office One

12631 East 17th Avenue


Aurora, CO 80045


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