UNIVERSITY OF KANSAS MEDICAL CENTER
2017 NICODEMUS STUDENT APPLICATION
Name ______Expected Graduation Year: ______
Address______
(number & street) (city) (state) (zip)
Summer Telephone#______Summer E-mail ______
Do you wish to receive one (1) credit hour in IDSP (for medical students) from the Nicodemus Project? ____Yes
____ No
Describe your interest or experience in health care for underserved and special populations.
(Use separate sheet of paper if necessary).
Describe your specific interest in The Nicodemus Project.
T-shirt / Scrub top size: S M L XL XXL XXXL
(Circle One)
PLEASE NOTE: The deadline for receipt of applications is July 3, 2017 by 5 p.m..
Completed applications must be returned by e-mail to Pamela Scott ()