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Degree
MD
DO
PhD
PA
NP
DDS
Social Work
Nursing
None
Other
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What languages do you speak?
English
Spanish
Arabic
Chinese
Tagalog
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Russian
German
Korean
Other
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Have you attended any of these conferences?
CCHF
GMHC
CMDA-Remedy
CMDA-other
None
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Are you currently a CMDA member?
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Have you attended a CMDA student group?
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Are you a US citizen or legal resident?
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What is your visa status?
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J-1
H-1B
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Do you have Medical Training Loans?
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What is your medical specialty?
Are you currently in training?
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What program are you attending?
Expected Date of Graduation
What program did you graduate from?
Where are you currently employed?
Are you bound by a contract?
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No
Are you fellowship trained?
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No
What area?
Do you have any malpractice suites/judgements?
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Yes
No
Please explain
When can you begin employment?
Are you seeking an explicitly Christian organization?
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Are you seeking a workplace that has missional training/mentorship?
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Yes
No
Do you feel called to any specific patient populations?
What type of hours are you seeking?
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Full-time
Part-time
Job Sharing
Preferred practice type/model?
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FQHC
Free and charitable
Direct Primary Care
Private Practice
Academic
No Preference
Preferred service environment?
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Urban
Rural
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Are you looking for a site that qualifies for NHSC loan repayment?
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If you are looking for a job in a particular area, please list it here:
How long have you been a Christian?
Please tell us about your faith/personal testimony:
Are you planning on eventually doing overseas missions?
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Yes
No
Unsure
How soon do you plan to go?
Do you have a particular place or people group identified?
How long do you plan on serving overseas?
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Long term
Short term (3 months or less)
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Do you have a heart or calling for working with refugees?
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Unsure
Have you read any books by John Perkins?
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No
Who?
How do you feel about living incarnationally?
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It's very important to me.
I'm open to it.
It's not for me.
I'm unsure.
Describe what you are searching for missionally in a practice/organization?
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