Pediatrics Visiting Rotation Application
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Demographic Information
Today's Date
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
Undergraduate City, State, and Country
Undergraduate Graduation Date
Medical School Education
Medical School Name
Medical School City, State, and Country
Anticipated Graduation Date
Type of Degree (DO, MD, MBBS, etc.)
Step/COMLEX Scores
Passing USMLE Step 1 or COMLEX 1 on the 1st attempt is a prerequisite for consideration of application. If Step 2 or COMLEX 2 are not yet taken, please indicate the anticipated date to take the exam.
USMLE Step I Score
Check this box if you passed USMLE Step I on 1st Attempt
USMLE Step II Score
Check this box if you passed USMLE Step II on 1st Attempt
COMLEX 1 Score
Check this box if you passed COMLEX 1 on 1st Attempt
COMLEX 2 Score
Check this box if you passed COMLEX 2 on 1st Attempt
Additional Information
Check if you have applied or intend to apply to our pediatric residency program.
How did you hear about our academic institution?
Please use this space to tell us additional information as you see fit (this may include biographical information or an explanation of discrepancies in your academic record).