Special Orthopaedic Student Online Elective Application
Questions marked with a * are required
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Demographic Information
Today's Date
Do you plan to apply to our Orthopaedic Surgery Program?
Contact Information
Date of Birth
Citizenship
Citizenship (Citizenship Country and Visa Status if not a US Citizen. We do not sponsor visas for medical students.)
Undergraduate Education
Undergraduate University
Degree
Graduation Date
Medical School Education
Medical School Name
Medical School City, State, and Country
Anticipated Graduation Date
Type of Degree (DO, MD, MBBS, etc.)
USMLE Step I Score
USMLE Step II Score (if available)
Medical School Class Rank
Medical School Awards/Honors
Elective Application Information
Check if you already applied for this elective via VSAS
Check if you plan to apply via VSAS in the next week
Check if you have submitted your medical school transcript in VSAS
Check if you are an osteopathic student and have/will have submitted our PDF application.
Check if you are an international student and have/will have submitted our PDF application
If you checked one of the last 2 boxes, email or fax your transcript to Donna.Gibson@erlanger.org, 423.778.9009. We must receive this to complete your application.
Requested Elective Dates (We strongly recommend you select dates that correspond to the UT block dates.)
1st Choice Beginning Date
1st Choice Ending Date
2nd Choice Beginning Date
2nd Choice Ending Date
3rd Choice Beginning Date
3rd Choice Ending Date
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