Elective/Selective Application Form – Northwest Institute of Health Sciences

Elective/Selective Application Form

Kindly fill in the following information and submit.

Name

Class

Email

Elective/Selective Site

Name of Hospital/Clinic/Site/Facility of Elective/Selective

Location/Address

Elective/Selective in the Discipline of

Name of Elective/Selective Supervisor if known

Email of Elective/Selective Supervisor

Date From

Date To

Total No. of Weeks Planned for Elective/Selective:

Define your Objectives for the intended Elective/Selective:

Educational/Training/Personal Objectives: (Describe how this Elective/Selective will contribute towards your Professional Career Goals)

Educational/Training/Personal Objectives: (Describe how this Elective/Selective will contribute towards your Professional Career Goals)