Report for Individually Designed Elective

Class Year: 
Title of Elective
Elective Faculty:
Elective Advisor:
Elective Coordinator:
End Week:
Length: weeks

Clinical (1 Page Report + Logbook)

Non-Clinical (2 Page Report)

Describe the Elective experience, including Objectives (were these objectives met?), and overall learning experience (i.e., a characterization of patient population served and/or professionals with whom you worked, as well as reflecting on what made this experience educationally worthwhile):

Word count:    (One page = approx. 500 single-spaced words.)

Would you recommend an individually-designed elective like this to other students?

Yes     No    

Do you have any suggestions for improvements to the elective?


If this rotation involved International Travel, please answer the following questions:

Are you willing to share your report and other pertinent information regarding this elective experience with future Classes as they consider International Travel? 

No, this report should remain confidential and may only be used to meet the course requirement for credit.

Yes, this report & other details listed below may be shared with under-classmates who may be interested in a similar elective experience. (Note:  Student names will be omitted before information is made available to others.)

Additional Optional Details

Location of trip:

Date of Trip & Length of Stay:

Contact association and/or person:

Pre-trip requirements (immunizations, visa, donations, supplies, etc.):

Accommodation details:

Approximate costs:

Other suggestions, tips, helpful information:



Contact us: 

Chris Reavis, MS (Curriculum Information)
Jean Afflerbach (Web Page)

Page Last Updated: 11/06/2019

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