Question Title

* 1. First Name

Question Title

* 2. Last Name

Question Title

* 3. What will be your residency program at the start of your PGY2 year?

Question Title

* 4. Please rank your months of availability in order of preference (first month = most preferred, last month = least preferred). If you are unavailable for a specific month, do not rank the month.

Question Title

* 5. At this time, we are not able to provide housing to residents on rotation. The rotation may be completed virtually or in person at the office in Irving, TX (with the resident arranging accommodations). For those completing the rotation in person, information about housing options and other logistics will be provided prior to the rotation (expected cost of housing is around $1500-2500).

In order to aid in scheduling, please indicate if you are likely to complete this rotation virtually or in person.

Question Title

* 6. Please answer the following essay questions in 250 words or less per question:

How does this elective rotation align with your career interests?

Question Title

* 7. What skills do you hope to gain from completing this rotation?

Question Title

* 8. Please attach your most up to date CV and letter of intent:

PDF, DOC, DOCX, PNG, JPG, JPEG, GIF file types only.
Choose File

Question Title

* 9. Please attach a signed copy of the Residency Program Director Approval Form.

PDF, DOC, DOCX, PNG, JPG, JPEG, GIF file types only.
Choose File
( Privacy & Cookie Notice

T