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MHA Summer Residency Preferences

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Please complete and submit to Amy Thaci by Monday, November 12^th, 2007. Please also email YOUR RESUME to thaci.1@osu.edu or in her HSMP office mailbox. Understand that your preferences will be taken into serious consideration and every effort will be made to make the best connection possible, but we can't guarantee a fit on every single item. The final decision rests with the residency organization. Thank you for your input!

General Information Name:
Phone Number (where you can be reached over Winter Break):
Location (City, State) over Winter Break:
Are you currently working? If so, please state where:

My Needs Include (check all that apply) I need help narrowing my focus and need exposure to many different management functions (e.g., planning, operations, finance, etc.) within an organization.
I have little/no work experience in healthcare and need exposure to a general health system environment.
I have experience in healthcare, but it is limited to this area: I need to broaden my experience.
I need the opportunity to network in this specific geographic area because this is where I hope to obtain a full time position/fellowship post-graduation.
I dont have a preference where I complete a residency, just connect me with a strong mentor.
I would like this to be the result from my residency (skills gained, etc):
Other Comments:

Organizational Area of Interest (check all that apply) Community Hospital
Academic medical center
Health System - corporate level
Health System - provider level
Hospital/Health System - any of the above
Ambulatory Care
Medical Group Practice
Consulting
Long-term care
Governmental
Policy
Association
Public Health Agency
Other:
Undecided

If you know of a particular organization(s) for which you would like to be considered, please list here:

General Area of Interest (check all that apply) Operations
Strategic Planning
Marketing and Communications
Finance
Human Resources
Organizational Development
Information systems/technology
Quality Improvement
Physician Relations
Legal
Community Relations/programs
Other:

General Environment (check all that apply) Location
Major metropolitan area
City
Rural
Doesn't matter

Size of organization
Large system, e.g, 10,000+ employees (such as OSU)
Medium system, e.g, 1000-10,000 employees
Small, e.g. 100-1000 employees
Very small/partnership, e.g, 2-100 employees
Doesn't matter

General Parameters (please note any restrictions or preferences) Geographic restrictions: I need a residency in the area(s).
Geographic preference: If possible, I prefer to be in the area(s).

Overall comments not noted previously:

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