Name: Click here to enter name
Date: Click here to enter date
School/Program: Click here to enter text
Area of Concentration: Click here to enter text
Availability:
Please underline weeks during which you will not be available from February 2015 – September 2015 due to exams, vacation, etc.
February – week of: 2nd 9th 16th 23rd
March – week of: 2nd 9th 16th 23rd 30th
April – week of: 6th 13th 20th 27th
May – week of: 4th 11th 18th 25th
June – week of: 1st 8th 15th 22nd 29th
July – week of: 6th 13th 20th 27th
August – week of: 3rd 10th 17th 24th 31st
September – week of: 7th 14th 21st 28th
What would you like to gain from participating in the Lyme Corps program?
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Please describe any previous experience related to public and/or health care provider education. This can be either general education or health-related topics.
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What kind of work do you enjoy doing?
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Plans for after you complete your degree?
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Where are you from?
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Do you have a car? (For logistical purposes only; your answer to this question will not affect selection)
Yes No. If No, can you readily access public transportation? Click here to enter text
Please provide one or two references of past preceptors or professors we can contact.
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Please enter your e-mail address here:
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Thank you for completing the Lyme Corps application for the Centers for Disease Control and Prevention. Please send your application to by Wednesday, Nov 12th. We will be in touch within 3-4 weeks regarding the decision on your application.