Special Orthopaedic Student Online Elective Application
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100%
Demographic Information
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Do you plan to apply to our Orthopaedic Surgery Program?
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Contact Information
Phone Number
First Name
Last Name
Middle Name
Street Address
City
State
Zip Code
Email Address
Date of Birth
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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
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Medical School Education
Medical School Name
Medical School City, State, and Country
Anticipated Graduation Date
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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
Yes
Check if you plan to apply via VSAS in the next week
Option 1
Check if you have submitted your medical school transcript in VSAS
Option 1
Check if you are an osteopathic student and have/will have submitted our PDF application.
Option 1
Check if you are an international student and have/will have submitted our PDF application
Option 1
If you checked one of the last 2 boxes, email or fax your transcript to
[email protected]
, 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
Month
Jan
Feb
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May
Jun
Jul
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Day
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Year
1970
1971
1972
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1977
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1980
1981
1982
1983
1984
1985
1986
1987
1988
1989
1990
1991
1992
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2002
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2009
2010
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2014
2015
2016
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2018
2019
2020
2021
2022
2023
2024
2025
1st Choice Ending Date
Month
Jan
Feb
Mar
Apr
May
Jun
Jul
Aug
Sep
Oct
Nov
Dec
Day
01
02
03
04
05
06
07
08
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10
11
12
13
14
15
16
17
18
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25
26
27
28
29
30
31
Year
1970
1971
1972
1973
1974
1975
1976
1977
1978
1979
1980
1981
1982
1983
1984
1985
1986
1987
1988
1989
1990
1991
1992
1993
1994
1995
1996
1997
1998
1999
2000
2001
2002
2003
2004
2005
2006
2007
2008
2009
2010
2011
2012
2013
2014
2015
2016
2017
2018
2019
2020
2021
2022
2023
2024
2025
2nd Choice Beginning Date
Month
Jan
Feb
Mar
Apr
May
Jun
Jul
Aug
Sep
Oct
Nov
Dec
Day
01
02
03
04
05
06
07
08
09
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
Year
1970
1971
1972
1973
1974
1975
1976
1977
1978
1979
1980
1981
1982
1983
1984
1985
1986
1987
1988
1989
1990
1991
1992
1993
1994
1995
1996
1997
1998
1999
2000
2001
2002
2003
2004
2005
2006
2007
2008
2009
2010
2011
2012
2013
2014
2015
2016
2017
2018
2019
2020
2021
2022
2023
2024
2025
2nd Choice Ending Date
Month
Jan
Feb
Mar
Apr
May
Jun
Jul
Aug
Sep
Oct
Nov
Dec
Day
01
02
03
04
05
06
07
08
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10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
Year
1970
1971
1972
1973
1974
1975
1976
1977
1978
1979
1980
1981
1982
1983
1984
1985
1986
1987
1988
1989
1990
1991
1992
1993
1994
1995
1996
1997
1998
1999
2000
2001
2002
2003
2004
2005
2006
2007
2008
2009
2010
2011
2012
2013
2014
2015
2016
2017
2018
2019
2020
2021
2022
2023
2024
2025
3rd Choice Beginning Date
Month
Jan
Feb
Mar
Apr
May
Jun
Jul
Aug
Sep
Oct
Nov
Dec
Day
01
02
03
04
05
06
07
08
09
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
Year
1970
1971
1972
1973
1974
1975
1976
1977
1978
1979
1980
1981
1982
1983
1984
1985
1986
1987
1988
1989
1990
1991
1992
1993
1994
1995
1996
1997
1998
1999
2000
2001
2002
2003
2004
2005
2006
2007
2008
2009
2010
2011
2012
2013
2014
2015
2016
2017
2018
2019
2020
2021
2022
2023
2024
2025
3rd Choice Ending Date
Month
Jan
Feb
Mar
Apr
May
Jun
Jul
Aug
Sep
Oct
Nov
Dec
Day
01
02
03
04
05
06
07
08
09
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
Year
1970
1971
1972
1973
1974
1975
1976
1977
1978
1979
1980
1981
1982
1983
1984
1985
1986
1987
1988
1989
1990
1991
1992
1993
1994
1995
1996
1997
1998
1999
2000
2001
2002
2003
2004
2005
2006
2007
2008
2009
2010
2011
2012
2013
2014
2015
2016
2017
2018
2019
2020
2021
2022
2023
2024
2025
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