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• Physicians & Clinicians
• Stipend Program
• Stipend Application
• FAQ

Personal Information

1. Name(required)
2. Address
3. City
4. State Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware Florida Georgia Hawaii Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming
5. Zip
6. Phone
7. Cell
8. Email(required)
9. Social Security Number
10. Date of Birth
11. Where You Born in Tennessee? Yes No
12. Describe your connection (familial and otherwise) to Tennessee.

How did you learn about the Tennessee Primary Care Residency Stipend Program?

Are you required to fulfill any type of service obligation?

2. Yes No

Date Residency Began

Projected Completion Date

Residency Program

1. Program Name
2. University

Underserved Areas

1. Are you willing to establish your practice in an underserved area of Tennessee? Yes No
2. If so, do you prefer East, Middle, or West Tennessee? East Middle West Not Interested

Personal Statement

1. Explain your desire to participate in The Rural Partnership’s Stipend Program and practice primary care in a rural/underserved area of Tennessee. Please note that the box below will scroll, so there is no limit on the length of your response.

To complete your application

1. Send the following certificates and references to stipend@theruralpartnership.com
   
   or
   
   Jackie Cavnar
   The Rural Partnership
   500 Interstate BLVD., Suite 203
   Nashville, TN 37210:
2. A: a letter from the your program director supporting this application and indicating good standing in the residency program;
3. B: final medical school transcript (sent directly by the medical school to The Rural Partnership);
4. C: evidence of citizenship (birth certificate, certificate of naturalization or permanent resident status); and
5. D: evidence of an unrestricted Tennessee medical license.

 

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