In the following section, enter the communities (A through D, if appropriate) in which you have lived the longest. Indicate the number of years you resided in each community (rounded to the nearest whole year). Include the community size by using one of the community designations (use the number) below.
Enclose a personal statement that explains why you are choosing to enter a primary care specialty. Include any previous community service experience that has had an impact on your decision to become a primary care physician. Also, include your professional goals and the special strengths you believe you may bring to a primary care specialty profession.
If YES addresses the funding source within your statement.
I certify that the information given in this application is accurate and complete to the best of my knowledge and belief. Fax or send the application and required information to the address provided on the application. We prefer receiving the information scanned to email@example.com.