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Dr Ral Antic AM Rural Health Grant
/ Dr Ral Antic AM Rural Health Grant Application
Dr Ral Antic AM Rural Health Grant Application
Personal details
Full name:
Current year level:
Email address:
Mobile telephone number:
Are you a domestic student or international?
Domestic student
International student
Elective supervisor details
Full name:
Position:
Email address:
Contact telephone number:
Elective details
Placement location:
Placement duration (days):
Proposed activities:
Justification
What value will you personally and/or educationally gain from this rural experience?
What value will you provide to the local health system or community while on placement?
How will this experience likely shape your future in rural medicine?
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