Dr Ral Antic AM Rural Health Grant Application

Full name:

Current year level:

Email address:

Mobile telephone number:

Full name:

Position:

Email address:

Contact telephone number:

Placement location:

Placement duration (days):

Proposed activities:

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?