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1. What type of submission is this?

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2. Medical School Name:

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3. Location:

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4. Name of Headache Faculty completing this survey:

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5. Title of Headache Faculty completing this survey:

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7. Rotation Duration:

(Most elective rotations are 2 or 4 weeks long)

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8. Please list any prerequisites.

(Standard requirement is an MS3 or MS4 who has completed their neurology clerkship rotation)

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9. Are you open to visiting students from other US-based medical schools?

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10. How far in advance does a student need to request the rotation?

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11. Do visiting students have access to any financial support from your institution? (check all that apply)

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12. What is the process for a visiting student to setup an elective at your institution?

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13. Program Description (2-3 sentences)

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14. Is the headache elective focused on pediatric, adult, or both?

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15. How many headache teaching attendings are in your department or division?

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16. Do you have a headache fellowship at the institution where the elective takes place?

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17. What types of experiences are offered as part of the elective rotation?

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18. Who is the best contact person for an interested medical student to reach out to?

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19. Institution Image

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