Special Orthopaedic Student Online Elective Application

Exit Survey

Questions marked with a * are required

100%

Demographic Information

Today's Date

Do you plan to apply to our Orthopaedic Surgery Program?

Yes

Contact Information

Phone Number

First Name

Last Name

Middle Name

Street Address

City

State

Zip Code

Email Address

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

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

1st Choice Ending Date

2nd Choice Beginning Date

2nd Choice Ending Date

3rd Choice Beginning Date

3rd Choice Ending Date