M3 Clerkships - Emergency Medicine Student Elective
Questions marked with a * are required
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Demographic Information
Today's Date
Phone where you can be reached:
Do you plan to apply to our Emergency Medicine Residency?
Contact Information
What is your date of birth?
Birthplace (City, State, Country)
Citizenship
Undergraduate Education
Undergraduate University
Degree(s) Awarded
Graduation Date
Medical School Education
Medical School
Location (City, State, Country)
Anticipated Graduation Date
USMLE Step I Score
USMLE Step II Score (if available)
Requested Elective Information
Check if you have already applied for this elective via VSAS.
Check if you will be applying via VSAS in the next week.
Check if you have submitted your medical school transcript via VSAS.
Check if you are an osteopathic student and are also submitting the pdf application.
Check if you are an international student and are also submitting the pdf application.
If you checked one of the previous 2 boxes, check here if you will be emailing or faxing your transcript to Velvet.Green@erlanger.org, 423.778.7677. We must receive this to complete your application.
Requested Elective Dates
We do not approve students outside 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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