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Medical Education Rotation Request

Students interested in rotating at Genesys Regional Medical Center, please fill out this application for a rotation. The Student Coordinator, will contact you after receiving your application. Please contact the specific program coordinator regarding resident rotations only. Due to the demand for rotations at Genesys, visiting students are limited to two (2) rotations per Academic year. Rotations are currently being scheduled through June 2017.

Enter Information into the fields below and when completed, press the “Submit ” button. This is considered an initial application for enrollment and does not guarantee a rotation.



DESIRED ROTATION:
First Choice:

 
Second Choice:

 
 
Rotation Dates:
Start of Rotation:
End of Rotation:
 
Housing Requested @ $50 per week (if available):
 
Gender
 
Contact Information:
Name:
Street Address:
City:
State:
Postal Code:
 
Birth Month/Day (mm/dd)
Last four digits of your SSN
 
E-mail Address:
Telephone #:
 
Do you require a Visa?
If yes, which one?
 
Medical School
Ant. Graduation Date
Degree
 
Please complete this section if this is an audition rotation:
Did you pass your boards on the first attempt?
 
Board Scores:
USMLE:
COMLEX:
 
Have you had to retake any classes?
 
Previous Rotations at Genesys?
Additional Comments:


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Please note that all correspondence will be done by e-mail and will be answered as soon as possible.
 

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