Apprenticeship Application GY2021- **CLOSED**

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APPLICATIONS NOW CLOSED.

Expectations for Apprenticeship:

1. You may not attend Apprenticeship during Sub-I, ICU, or EM rotations.

2. Notify the administrators of your Branches rotations in advance of all Apprenticeship half-days. You must still attend any mandatory rotation requirements.

3. Select one half-day when most of your Apprenticeship sessions will be. It is permissible to occasionally do different half-days as long as approval is given from existing rotation.

4. The Apprenticeship dates must correspond with one of the date ranges specified in the application. Shorter experiences cannot count as an Apprenticeship.

5. Identify one faculty preceptor who you will spend most of your time working with and who can fill out assessments at the end of each term.

6. You may not attend the Apprenticeship while on a Leave of Absence or otherwise not enrolled at the medical school. You must be enrolled in the medical school for the ENTIRE duration of any of the terms you select below.

Please contact Dr. Walford (ewalford@med.umich.edu) or Samiah Haque (samhaque@med.umich.edu) with any questions.

Email *

Name *

Email *

Branch *

Apprenticeship Faculty Advisor (cannot be your Branch Advisor) *

Apprenticeship Faculty Advisor email address *

In what clinic/location will your Apprenticeship take place? *

Select one date range below that best matches the dates you are planning to attend Apprenticeship sessions. These are the dates when you will be enrolled in the Apprenticeship elective. It is fine if the dates are off by roughly 1-2 months. You MUST be enrolled in the medical school for the entire duration of any of the terms you select below. You MUST attend at least one session during each term you sign up for. *

CLOSED

Half-day of the week you are planning to do the Apprenticeship: *

Create a list of 3-5 learning objectives for your Apprenticeship. These will be used to develop a learning plan so that your advisor, branch director, and the Branches Competency Committee can monitor your progress. The goals must be S.M.A.R.T. (specific, measurable, achievable, relevant, time bound): *

By submitting this form, I agree to adhere to the expectations above. Please submit your name here. *

A copy of your responses will be emailed to the address you provided.

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