Application - Clinical/Scholarly Experience for UT M1s
Questions marked with a * are required
Contact Information
Are you a UTHSC College of Medicine student?
Are you a UTHSC M1 student?
What year will you graduate medical school?
Department Opportunities
Opportunities are available in Emergency Medicine, Family Medicine, Neurology, Surgery, and Urology.
Enter your 1st choice of department opportunities from the above list.
Enter your 2nd choice of department opportunities from the above list.
Beginning date you are available for the immersion experience:
Ending date you would be available for the immersion experience:
Please list any medical condition(s) of which we should be aware.
Emergency Contact Information
If a bedroom were available in the apartments leased for students, would you like to request housing with us?
Note: Housing is not available for spouses or families of students.

Documentation Required (in addition to this online application):
  • Current CV
  • Email your photo (headshot) as a .jpg or .png file
  • Statement of interest about the program in a one-page narrative (400 words or less)
  • Immunization record with proof of MMR, chickenpox immunity, and negative TB skin test within the past 12 months
  • Copy of HIPAA training from UTHSC
  • Copy of CITI Certificate from UTHSC
  • Letter of good academic academic standing from the Office of Medical Education at UTHSC Memphis
Required documentation should be emailed to

Questions: If you have questions about the immersion experience or your application, please contact the Office of Graduate and Medical Student Education in Chattanooga at 423.778.7442 or email
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