Medical Professional Reference In-take

Your Full Name*

First Middle Last

Your Email Address*

Team Number*

Level of Experience or Training*

Strengths and Weaknesses*

This will help our professional measure your growth and accurately evaluate you at the end of the program.

Learning Goals*

What are you hoping to gain from this experience?

e-Signature*

By signing this you are acknowledging that if your performance does not meet the expectations of the program, you will not be receiving a letter of recommendation. No refunds will be issued after the program start date. You are responsible for your own outcome! You will have the opportunity to review your performance with the supervising medical professional should you wish, however the summary evaluations and letters of recommendation will remain private for credibility purposes.

Our goal is to provide experiential learning opportunities and cultural expansion for education majors and professionals while experiencing first-hand classroom experience in a co-teaching format, assisting educators around the world.