Wetzel Fellow Application

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Name *

First

Last

Email *

Address Line 1 *

City *

State *

Zip Code *

Phone Number *

COM *

Year of Graduation *

Program Director Name *

Program Director Phone Number *

Program Director Email *

Postgraduate Training Program *

Specialty *

I can attend the entire Missouri Osteopathic Annual Convention. *

Yes
No

I intend to practice in the state of Missouri upon completion of postgraduate training. *

Yes
No

I have read and understand all requirements and expectations of the Wetzel Fellowship Program. *

Yes
No

I understand that Fellowship funds are to be used for expenses related to the cost of my education. *

Yes
No

If selected as a finalist, I will be available for an interview with MAOPS leadership. *

Yes
No

Describe how you maintain a healthy work/life balance. *

Provide a detailed example of how you have demonstrated leadership sometime in the last three years. *

Explain why you believe you're the ideal candidate for this fellowship. *

Applicant's initials in lieu of signature

Letter of Reference #1 *

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Letter of Reference #2 *

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1423 Randy Lane | Jefferson City, MO 65101
Phone: 573-634-3415 | Fax: 573-634-5635 • Email MAOPS

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The Missouri Association of Osteopathic Physicians and Surgeons (MAOPS) was founded in 1897 in Kirksville, MO – the birthplace of osteopathic medicine – as the professional organization for physicians holding Doctor of Osteopathic Medicine (DO) degrees.