Documentos de Académico
Documentos de Profesional
Documentos de Cultura
Name:__________________________________________ Institution:_______________________________________
Address:_______________________________________ Address: ________________________________________
_______________________________________________ ________________________________________________
Telephone #:____________________________________ ________________________________________________
E-Mail:_________________________________________ Contact Person:___________________________________
Expected date of graduation:______________________ E-mail:__________________________________________
Current Training Level:__________________________ Telephone #______________________________________
Total amount of time planned at the College of Medicine, School of Community Medicine (# of weeks)__________
Signature:________________________________________ Title:___________________________________________
Section III: To be completed by Department, The University of Oklahoma, College of Medicine, School of
Community Medicine The above observation is approved as requested.
Name:___________________________________________ Title:____________________________________________
Signature:________________________________________ Department:_____________________________________
Place:_____________________________________________ Time:___________________________________________
Telephone #:______________________________________ E-mail __________________________________________
Section IV:
The above observation is approved as requested. Approved with the following changes
__________________________________________________ ___________________________________________
Office of Academic Services _____________________________________________________
The University of Oklahoma _____________________________________________________
College of Medicine, School of Community Medicine 1.