Medical Education Application - Genesys Health System | Grand Blanc, MI

Application Process:

Allopathic Family Practice Resident Applications are only accepted through ERAS. Visit http://www.myeras.aamc.org to apply

PGYI applications are only accepted through ERAS. Visit http://www.myeras.aamc.org to apply

- Osteopathic Resident (PGYII and above) Application complete the form below:

NOTE: Applications will be accepted starting July, 2007 for the academic year beginning July, 2008. Thank you for your interest in Genesys Regional Medical Center.

View the Application/Interview Deadlines

Please provide all the information requested.

Residency Requested Beginning Date: JULY of

Last Name:
First Name:
Middle Initial:
SSN	- -

Current Address
City
State
Zip
E-Mail
Phone	( ) -

Medical School

Are you legally able to work in the United States? Yes No

If your current address is the same as your permanent address, check the following box, and move to the next section of this application.
My permanent address is the same as my current address
Permanent Address

City

State

Zip

Internship Location (Hospital)

Completion Date

Address:

City:

State:

Postal Code:

Have you served as a Resident in any other hospital?

Hospital	Program	Date

Residency Requested

All Applicants Complete:
Pre-Osteopathic College/University:

Name & Address of School	Years Attended	Degree

Osteopathic College/University:

Name & Address of School	Years Attended	Degree

Please complete the following questions.

Why are you interested in the specialty or subspecialty you have indicated?

Why are you interested in a residency at our hospital?

Please write a short paragraph on your background. Include information on training or relevant experiences that you would like to have considered.

Before you will be considered for an interview, we must have:

Resident Applicants:

The completed application (typed)
Two letters of professional reference
Letter from medical school Dean’s office sent directly to us
Letter from the Director of Medical Education where you served or are serving your internship
Official copy of your medical school transcripts and board scores
Curriculum Vitae

**(Orthopedic applicants: Official Undergraduate Transcripts)

Before beginning your residency at Genesys, we require:

Copies of your current BLS and ACLS cards.
Copy of your internship diploma when received.
Copy of current Michigan license.

This information can be mailed to:
Genesys Regional Medical Center
Medical Education
One Genesys Parkway
Grand Blanc, MI 48439
Attn: Mindy Valigura
Fax: (810) 606-5990

References:
Please list the names of two references from whom we can expect reference letters.

Name	Organization Affiliation

Would you like to receive emails from Genesys in the future? Yes No