Student Field Trip Registration Student InformationName(Required) First Last UAMS Email(Required) Phone(Required)Class(Required) 2026 2027 2028 Please note any dietary restrictions.Please share any other pertinent information.Practice IntentHow much do you intend, plan, or want to work in primary care?(Required) Definitely Probably Maybe Probably Not Not At All How much do you intend, plan, or want to work in a rural area?(Required) Definitely Probably Maybe Probably Not Not At All How much do you intend, plan, or want to work with patients who are medically underserved?(Required) Definitely Probably Maybe Probably Not Not At All How much do you intend, plan, or want to attend residency training in Arkansas?(Required) Definitely Probably Maybe Probably Not Not At All How much do you intend, plan, or want to practice in Arkansas?(Required) Definitely Probably Maybe Probably Not Not At All
